Provider Demographics
NPI:1609949767
Name:WILTZEN, WENDY K (FNPC)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:K
Last Name:WILTZEN
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 14TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:MT
Mailing Address - Zip Code:59270-3521
Mailing Address - Country:US
Mailing Address - Phone:406-488-2501
Mailing Address - Fax:406-488-2149
Practice Address - Street 1:214 14TH AVE SW
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:MT
Practice Address - Zip Code:59270-3521
Practice Address - Country:US
Practice Address - Phone:406-488-2501
Practice Address - Fax:406-488-2149
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN14607363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000372600OtherBLUE CROSS OF MT
MT0436917Medicaid
ND15860Medicaid
ND15860Medicaid
MTP23987Medicare UPIN
MT0436917Medicaid