Healthcare Provider Details

I. General information

NPI: 1669270997
Provider Name (Legal Business Name): KATIE WAGNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2025
Last Update Date: 03/04/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 NEW HOSPITAL CIRCLE
BROWNING MT
59417
US

IV. Provider business mailing address

760 BLACKWEASEL ROAD
BROWNING MT
59417
US

V. Phone/Fax

Practice location:
  • Phone: 406-338-6240
  • Fax: 406-338-6384
Mailing address:
  • Phone: 406-338-6240
  • Fax: 406-338-6384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number47446
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: