MEDICARE: DR. CLAIRE EILEEN THRALLS PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	NUR-APRN-LIC-177218	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NUR-APRN-LIC-177218	OTHER	MT	STATE ISSUED LICENSE NUMBER

General Provider Information

NPI Number	:	1982378238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLAIRE EILEEN THRALLS PMHNP

Provider Business Mailing Address
First Line	:	1745 S 9TH ST W
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59801-3432
Country	:	US
Telephone Number	:	406-207-7442
Fax Number	:

Provider Business Practice Location Address
First Line	:	725 SW HIGGINS AVE STE D
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59803-1420
Country	:	US
Telephone Number	:	406-207-7442
Fax Number	:

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

Provider Enumeration Date	:	08/02/2021
Last Update Date	:	11/01/2021

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