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NPI Code Detail

MEDICARE: DEANNA LEE NILES PA-C

MEDICARE:   DEANNA LEE NILES  PA-C
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
1363A00000XPhysician Assistant643MTMT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MT 643OTHERMTMT LICENSE
2332WYOTHERWYWY MEDICAL LICENSE #

General Provider Information

NPI Number : 1881666261
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEANNA LEE NILES PA-C
Provider Business Mailing Address
First Line : 123 S 27TH ST
Second Line :
City : BILLINGS
State : MT
Zip : 59101-4227
Country : US
Telephone Number : 406-967-2255
Fax Number : 405-967-2251
Provider Business Practice Location Address
First Line : 123 S 27TH ST
Second Line :
City : BILLINGS
State : MT
Zip : 59101-4227
Country : US
Telephone Number : 406-967-2255
Fax Number : 405-967-2251
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2006
Last Update Date : 03/07/2023

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Directions to “ DEANNA LEE NILES PA-C” Practice Location

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