Provider Demographics
NPI:1578574067
Name:SAWITKE, DIANNE WICKHAM (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:WICKHAM
Last Name:SAWITKE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MS
Other - First Name:DIANNE
Other - Middle Name:
Other - Last Name:WICKHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:530 N MONTANA ST
Mailing Address - Street 2:TRINA HEALTH OF MONTANA
Mailing Address - City:DILLON
Mailing Address - State:MT
Mailing Address - Zip Code:59725-3315
Mailing Address - Country:US
Mailing Address - Phone:406-988-0721
Mailing Address - Fax:406-988-0724
Practice Address - Street 1:530 N MONTANA ST
Practice Address - Street 2:TRINA HEALTH OF MONTANA
Practice Address - City:DILLON
Practice Address - State:MT
Practice Address - Zip Code:59725-3315
Practice Address - Country:US
Practice Address - Phone:406-988-0721
Practice Address - Fax:406-988-0724
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-100581363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT4305730Medicaid
P25982Medicare UPIN
P25982Medicare UPIN