MEDICARE: DANIEL MASAR FNP-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
1	363LF0000X	Family Nurse Practitioner	NUR-RN-LIC-28603	MT

General Provider Information

NPI Number	:	1962870311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL MASAR FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 1375
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59903-1375
Country	:	US
Telephone Number	:	406-233-9326
Fax Number	:

Provider Business Practice Location Address
First Line	:	2165 9TH ST W
Second Line	:
City	:	COLUMBIA FALLS
State	:	MT
Zip	:	59912-4416
Country	:	US
Telephone Number	:	406-892-3208
Fax Number	:

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

Provider Enumeration Date	:	09/02/2015
Last Update Date	:	09/02/2015

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