Healthcare Provider Details

I. General information

NPI: 1720192370
Provider Name (Legal Business Name): BRENDA M. WIPPLINGER LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 WYOMING ST
MISSOULA MT
59801-1725
US

IV. Provider business mailing address

T-9 FORT MISSOULA
MISSOULA MT
59804-7202
US

V. Phone/Fax

Practice location:
  • Phone: 406-532-9700
  • Fax:
Mailing address:
  • Phone: 406-532-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number8301
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: