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General NPI Number Information
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NPI Number | 1619737673
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Entity Type | Individual
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Provider Name | KATHERINE TYREE
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Gender | Female
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Dates
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Enumeration Date | 03/19/2024
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Last Update Date | 03/19/2024
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Provider Practice Location Address
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Address Line | 2415 S CATLIN ST
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City | MISSOULA
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State | MT
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Zip | 59801-7822
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Country | US
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Telephone | 406-549-0114
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Fax |
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Provider Business Mailing Address
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Address Line | 8444 N 90TH ST STE 100
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-4437
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | NUR-LPN-LIC-215592
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License Number State | MT
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