Healthcare Provider Details

I. General information

NPI: 1508714965
Provider Name (Legal Business Name): STEPHANIE WITBROD FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2192 N MISSION DR
KALISPELL MT
59901-2260
US

IV. Provider business mailing address

2192 N MISSION DR
KALISPELL MT
59901-2260
US

V. Phone/Fax

Practice location:
  • Phone: 406-249-0938
  • Fax:
Mailing address:
  • Phone: 406-249-0938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNUR-APRN-LIC-287392
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: