Healthcare Provider Details

I. General information

NPI: 1023769973
Provider Name (Legal Business Name): LEWISTOWN ADULT HEALTH AND WOUND CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 02/18/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 NE MAIN ST STE 2
LEWISTOWN MT
59457-4000
US

IV. Provider business mailing address

611 NE MAIN ST STE 2
LEWISTOWN MT
59457-4000
US

V. Phone/Fax

Practice location:
  • Phone: 406-350-4067
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: WENDY L MADDUX
Title or Position: SOLE MEMBER OWNER
Credential: A-GNP-C
Phone: 406-561-3084