Provider Demographics
NPI:1720540677
Name:MILLIGAN, REBECCA J (FNP-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:MILLIGAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:J
Other - Last Name:WASHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:309 CENTRAL AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-2679
Mailing Address - Country:US
Mailing Address - Phone:406-213-9591
Mailing Address - Fax:
Practice Address - Street 1:160 HERITAGE WAY STE 103
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3127
Practice Address - Country:US
Practice Address - Phone:406-871-6226
Practice Address - Fax:406-758-7925
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-RN-LIC-40620163W00000X
MTNUR-APRN-LIC-160710363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT363LF0000XMedicaid