Healthcare Provider Details

I. General information

NPI: 1225886252
Provider Name (Legal Business Name): CONOR DYSINGER FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 RADIO WAY
MISSOULA MT
59808-1385
US

IV. Provider business mailing address

1246 S 6TH ST W
MISSOULA MT
59801-3539
US

V. Phone/Fax

Practice location:
  • Phone: 406-541-3046
  • Fax:
Mailing address:
  • Phone: 406-871-6502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number237688
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: