Provider Demographics
NPI:1982968699
Name:SWARTZ, NICOLE A (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:A
Last Name:SWARTZ
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MRS
Other - First Name:NICOLE
Other - Middle Name:ANN
Other - Last Name:DONISTHORPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:2831 FORT MISSOULA RD
Mailing Address - Street 2:SUITE 232
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-7419
Mailing Address - Country:US
Mailing Address - Phone:406-728-6101
Mailing Address - Fax:406-721-3278
Practice Address - Street 1:2831 FORT MISSOULA RD
Practice Address - Street 2:SUITE 232
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-7419
Practice Address - Country:US
Practice Address - Phone:406-728-6101
Practice Address - Fax:406-721-3278
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT39695363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily