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General NPI Number Information
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NPI Number | 1689102899
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Entity Type | Individual
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Provider Name | GREG WISER
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Gender | Male
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Dates
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Enumeration Date | 06/01/2017
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Last Update Date | 06/01/2017
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Provider Practice Location Address
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Address Line | 10 THREE MILE DR
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City | KALISPELL
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State | MT
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Zip | 59901-3034
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Country | US
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Telephone | 406-257-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 750 LA BRANT RD
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City | KALISPELL
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State | MT
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Zip | 59901-8233
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Country | US
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Telephone | 812-801-5733
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | HAD-HAD-LIC-1291
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License Number State | MT
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