Provider Demographics
NPI:1346589462
Name:PFEIFER, NICOLE DIANE (FNP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:DIANE
Last Name:PFEIFER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:DIANE
Other - Last Name:QUIGLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 12
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0012
Mailing Address - Country:US
Mailing Address - Phone:866-747-2455
Mailing Address - Fax:
Practice Address - Street 1:601 W SPRUCE ST STE K4TH
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4057
Practice Address - Country:US
Practice Address - Phone:406-327-1950
Practice Address - Fax:406-327-3080
Is Sole Proprietor?:No
Enumeration Date:2013-02-08
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-100688363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
M011003196Medicare PIN