Healthcare Provider Details

I. General information

NPI: 1982968699
Provider Name (Legal Business Name): NICOLE A SWARTZ FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE ANN DONISTHORPE FNP-BC

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2831 FORT MISSOULA RD SUITE 232
MISSOULA MT
59804-7419
US

IV. Provider business mailing address

2831 FORT MISSOULA RD SUITE 232
MISSOULA MT
59804-7419
US

V. Phone/Fax

Practice location:
  • Phone: 406-728-6101
  • Fax: 406-721-3278
Mailing address:
  • Phone: 406-728-6101
  • Fax: 406-721-3278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number39695
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: