Healthcare Provider Details

I. General information

NPI: 1356917561
Provider Name (Legal Business Name): DEREK A WEISS FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2021
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N OAK ST
TOWNSEND MT
59644-2306
US

IV. Provider business mailing address

57 SAUTTER LN
TOWNSEND MT
59644-9641
US

V. Phone/Fax

Practice location:
  • Phone: 406-266-3186
  • Fax:
Mailing address:
  • Phone: 907-220-6993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number175753
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: