MEDICARE: MRS. VICKI LYNN THUESEN MSN FNP WHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	RN9284	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	374740	OTHER	MT	BCBS PROVIDER NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629298393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VICKI LYNN THUESEN MSN FNP WHNP

Provider Business Mailing Address
First Line	:	9801 VALLEY GROVE DR
Second Line	:
City	:	LOLO
State	:	MT
Zip	:	59847-8617
Country	:	US
Telephone Number	:	406-273-4633
Fax Number	:	406-273-4707

Provider Business Practice Location Address
First Line	:	9801 VALLEY GROVE DR
Second Line	:
City	:	LOLO
State	:	MT
Zip	:	59847-8617
Country	:	US
Telephone Number	:	406-273-4633
Fax Number	:	406-273-4707

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	09/01/2020

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