Healthcare Provider Details

I. General information

NPI: 1528725637
Provider Name (Legal Business Name): SADRA THOMAS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 CENTRAL AVE
GREAT FALLS MT
59401-3124
US

IV. Provider business mailing address

1113 VALLEY VIEW DR
GREAT FALLS MT
59404-1768
US

V. Phone/Fax

Practice location:
  • Phone: 406-604-1137
  • Fax: 833-468-4817
Mailing address:
  • Phone: 406-604-1137
  • Fax: 833-468-4817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number177534
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: