Healthcare Provider Details

I. General information

NPI: 1396008231
Provider Name (Legal Business Name): HEIDI WOXLAND DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2012
Last Update Date: 11/27/2023
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 RIDGEWATER DR SUITE A
POLSON MT
59860-8977
US

IV. Provider business mailing address

106 RIDGEWATER DR SUITE A
POLSON MT
59860-8977
US

V. Phone/Fax

Practice location:
  • Phone: 406-883-3200
  • Fax: 406-883-9483
Mailing address:
  • Phone: 406-883-3200
  • Fax: 406-883-9483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number60964
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number51643
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: