Healthcare Provider Details

I. General information

NPI: 1437368487
Provider Name (Legal Business Name): KATY WESSEL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 03/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 PTARMIGAN LN
HELENA MT
59602-0521
US

IV. Provider business mailing address

PO BOX 6369
HELENA MT
59604-6369
US

V. Phone/Fax

Practice location:
  • Phone: 406-457-4180
  • Fax:
Mailing address:
  • Phone: 406-457-4180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11819
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberLL16043
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: