Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 29947 | MT |
NPI | 1003076639 |
---|---|
Provider Name | Nicolett M Weston |
First Address | Hamilton, MT 59840-2338 |
Second Address | Corvallis, MT 59828-9374 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2008 |
Last Update Date | 05/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003076639 | (05) | ID |
1003076639 | (05) | MT |
1003076639 | (05) | WA |