Organization
ONE LIFE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEXIS D WAGNER (PRESIDENT)
(406) 360-2101
Entity
Organization
Contact information
Practice address
186 S. THIRD STREET, HAMILTON, MT 59066
(406) 360-2101
Mailing address
211 BEAN CREEK RD. #12, SCOTTS VALLEY, CA 95066
(406) 360-2101
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN 16715
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43000813
—
MT
05
—
9982706
—
MT
Enumeration date
11/02/2006
Last updated
08/22/2020
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