Provider Demographics
NPI:1790108124
Name:BILLEADEAUX, NIYA C (RN)
Entity Type:Individual
Prefix:
First Name:NIYA
Middle Name:C
Last Name:BILLEADEAUX
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 880
Mailing Address - Street 2:
Mailing Address - City:ST. IGNATIUS
Mailing Address - State:MT
Mailing Address - Zip Code:59865
Mailing Address - Country:US
Mailing Address - Phone:406-745-3525
Mailing Address - Fax:406-745-3529
Practice Address - Street 1:33116 U.S. HWY 93 N.
Practice Address - Street 2:
Practice Address - City:ELMO
Practice Address - State:MT
Practice Address - Zip Code:59914
Practice Address - Country:US
Practice Address - Phone:406-745-3525
Practice Address - Fax:406-745-3529
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-21
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT68215163W00000X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163W00000XNursing Service ProvidersRegistered Nurse