Provider Demographics
NPI:1629298393
Name:THUESEN, VICKI LYNN (MSN FNP WHNP)
Entity Type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:LYNN
Last Name:THUESEN
Suffix:
Gender:F
Credentials:MSN FNP WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9801 VALLEY GROVE DR
Mailing Address - Street 2:
Mailing Address - City:LOLO
Mailing Address - State:MT
Mailing Address - Zip Code:59847-8617
Mailing Address - Country:US
Mailing Address - Phone:406-273-4633
Mailing Address - Fax:406-273-4707
Practice Address - Street 1:9801 VALLEY GROVE DR
Practice Address - Street 2:
Practice Address - City:LOLO
Practice Address - State:MT
Practice Address - Zip Code:59847-8617
Practice Address - Country:US
Practice Address - Phone:406-273-4633
Practice Address - Fax:406-273-4707
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN9284363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT374740OtherBCBS PROVIDER NUMBER
MT4305535Medicaid
MTS38019Medicare UPIN
MT000084621Medicare ID - Type Unspecified