Provider Demographics
NPI:1821631011
Name:WEISS, TRAVIS JOHN (RN)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:JOHN
Last Name:WEISS
Suffix:
Gender:M
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:PO BOX 485
Mailing Address - Street 2:
Mailing Address - City:CANYON CREEK
Mailing Address - State:MT
Mailing Address - Zip Code:59633-0485
Mailing Address - Country:US
Mailing Address - Phone:603-502-1657
Mailing Address - Fax:
Practice Address - Street 1:200 WINGS WAY
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-3556
Practice Address - Country:US
Practice Address - Phone:603-502-1657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-PARA-LIC-31801146L00000X
MTNUR-RN-LIC-72439163WC0200X, 163WF0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WF0300XNursing Service ProvidersRegistered NurseFlight
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine