1760509384 NPI number — DR. IAN ADDISON NESBIT NATUROPATH ND

Table of content: DR. IAN ADDISON NESBIT NATUROPATH ND (NPI 1760509384)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760509384 NPI number — DR. IAN ADDISON NESBIT NATUROPATH ND

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NESBIT
Provider First Name:
IAN
Provider Middle Name:
ADDISON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
NATUROPATH ND
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NESBIT
Provider Other First Name:
IAN
Provider Other Middle Name:
ADDISON
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ND
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1760509384
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4074
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MISSOULA
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59806-4074
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-541-7672
Provider Business Mailing Address Fax Number:
406-541-0672

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2016 STRAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MISSOULA
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59801-5435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-728-0978
Provider Business Practice Location Address Fax Number:
406-728-0978
Provider Enumeration Date:
03/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 175F00000X , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AHC-NAT-LIC-47 . This is a "ALTERNATIVE HEALTH BOARD" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




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