Provider Demographics
NPI:1710522677
Name:WENSEL, KILEY (CNM)
Entity Type:Individual
Prefix:
First Name:KILEY
Middle Name:
Last Name:WENSEL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4166
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-4166
Mailing Address - Country:US
Mailing Address - Phone:406-249-1849
Mailing Address - Fax:
Practice Address - Street 1:210 SUNNYVIEW LN STE 101
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3128
Practice Address - Country:US
Practice Address - Phone:406-751-8009
Practice Address - Fax:406-257-6436
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-14
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT146219367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife