Healthcare Provider Details

I. General information

NPI: 1043385248
Provider Name (Legal Business Name): MARIANNE M. WILSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 11/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 2ND STREET SE
CUT BANK MT
59427
US

IV. Provider business mailing address

802 2ND STREET SE
CUT BANK MT
59427
US

V. Phone/Fax

Practice location:
  • Phone: 406-873-2236
  • Fax: 406-873-2867
Mailing address:
  • Phone: 406-873-2236
  • Fax: 406-873-2867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number013820809
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN2262
License Number StateMT

VIII. Authorized Official

Name: MS. MARIANNE M. WILSON
Title or Position: OWNER DIRECTOR
Credential: RNC
Phone: 406-873-2236