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General NPI Number Information
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NPI Number | 1790802593
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Entity Type | Individual
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Provider Name | MR. GARY ALAN WINGFIELD
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Gender | Male
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Dates
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Enumeration Date | 03/25/2007
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 1300 SPEEDWAY AVE
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City | MISSOULA
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State | MT
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Zip | 59802-5566
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Country | US
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Telephone | 406-549-8127
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Fax | 406-542-5202
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Provider Business Mailing Address
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Address Line | 1300 SPEEDWAY AVE
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City | MISSOULA
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State | MT
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Zip | 59802-5566
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Country | US
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Telephone | 406-549-8127
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Fax | 406-542-5202
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 10995
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License Number State | MT
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