MEDICARE: MRS. LAURA WETHERELT APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	RN19128	MT
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	100277	MT

General Provider Information

NPI Number	:	1689641052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURA WETHERELT APRN

Provider Business Mailing Address
First Line	:	PO BOX 4
Second Line	:
City	:	FORSYTH
State	:	MT
Zip	:	59327-0004
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2911 WILSON ST
Second Line	:
City	:	MILES CITY
State	:	MT
Zip	:	59301-5722
Country	:	US
Telephone Number	:	406-234-2929
Fax Number	:	406-234-2928

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2006
Last Update Date	:	07/27/2020

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