Healthcare Provider Details

I. General information

NPI: 1962102913
Provider Name (Legal Business Name): CARY WASKO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2023
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 ALPENGLOW LN
LIVINGSTON MT
59047-8506
US

IV. Provider business mailing address

320 ALPENGLOW LN
LIVINGSTON MT
59047-8506
US

V. Phone/Fax

Practice location:
  • Phone: 406-222-3541
  • Fax: 406-222-9971
Mailing address:
  • Phone: 406-222-3541
  • Fax: 406-222-9971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNUR-APRN-LIC-235765
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0033540
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberNUR-RN-LIC-235033
License Number StateMT
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.361550
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: