Healthcare Provider Details

I. General information

NPI: 1518421049
Provider Name (Legal Business Name): NICOLA WILDE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2019
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 BIRCH ST
HELENA MT
59601-0606
US

IV. Provider business mailing address

PO BOX 1342
HELENA MT
59624-1342
US

V. Phone/Fax

Practice location:
  • Phone: 406-465-2223
  • Fax:
Mailing address:
  • Phone: 406-465-2223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number32593
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: