Healthcare Provider Details

I. General information

NPI: 1609949767
Provider Name (Legal Business Name): WENDY K WILTZEN FNPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 14TH AVE SW
SIDNEY MT
59270-3521
US

IV. Provider business mailing address

214 14TH AVE SW
SIDNEY MT
59270-3521
US

V. Phone/Fax

Practice location:
  • Phone: 406-488-2501
  • Fax: 406-488-2149
Mailing address:
  • Phone: 406-488-2501
  • Fax: 406-488-2149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN14607
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: