Healthcare Provider Details

I. General information

NPI: 1245166263
Provider Name (Legal Business Name): ANNALISE WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 814
KILA MT
59920-0814
US

IV. Provider business mailing address

PO BOX 814
KILA MT
59920-0814
US

V. Phone/Fax

Practice location:
  • Phone: 406-261-2040
  • Fax:
Mailing address:
  • Phone: 406-000-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number32227
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: