Provider Demographics
NPI:1295435840
Name:WIEBE, DYLAN JON (FNP)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:JON
Last Name:WIEBE
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1547 TANIA CIR
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-1873
Mailing Address - Country:US
Mailing Address - Phone:406-465-3230
Mailing Address - Fax:
Practice Address - Street 1:16 N MILES AVE STE 101
Practice Address - Street 2:
Practice Address - City:HARDIN
Practice Address - State:MT
Practice Address - Zip Code:59034-2356
Practice Address - Country:US
Practice Address - Phone:406-665-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-213350363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care