Provider Demographics
NPI:1710947726
Name:WEINBERGER, ANNE M (APRN)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:M
Last Name:WEINBERGER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-2338
Mailing Address - Country:US
Mailing Address - Phone:406-375-4823
Mailing Address - Fax:406-375-4846
Practice Address - Street 1:1200 WESTWOOD DR
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2345
Practice Address - Country:US
Practice Address - Phone:406-363-5101
Practice Address - Fax:406-363-7652
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC222761363L00000X
MT67813363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004143Medicaid
WI005016130OtherMEDICARE PTAN
NC2345549OtherMEDICARE GROUP PTAN
ID1710947726Medicaid
MT1710947726Medicaid
NC2345549OtherMEDICARE GROUP PTAN
MTM011003170, MDMHMedicare PIN
ID1710947726Medicaid
MTM011003166, BPCMedicare PIN