Healthcare Provider Details

I. General information

NPI: 1629298393
Provider Name (Legal Business Name): VICKI LYNN THUESEN MSN FNP WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 09/01/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9801 VALLEY GROVE DR
LOLO MT
59847-8617
US

IV. Provider business mailing address

9801 VALLEY GROVE DR
LOLO MT
59847-8617
US

V. Phone/Fax

Practice location:
  • Phone: 406-273-4633
  • Fax: 406-273-4707
Mailing address:
  • Phone: 406-273-4633
  • Fax: 406-273-4707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN9284
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: