Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | NUR-APRN-LIC-104255 | MT |
NPI | 1003269135 |
---|---|
Provider Name | Anna Victoria Nesovic |
First Address | Billings, MT 59101-0703 |
Second Address | Billings, MT 59101-0703 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2016 |
Last Update Date | 01/08/2016 |