Provider Demographics
NPI:1760991020
Name:WALSH, BREANNE M (NP-C)
Entity Type:Individual
Prefix:
First Name:BREANNE
Middle Name:M
Last Name:WALSH
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:BREANNE
Other - Middle Name:M
Other - Last Name:HANKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1805 OAK ST
Mailing Address - Street 2:STE 3
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-8735
Mailing Address - Country:US
Mailing Address - Phone:406-414-4891
Mailing Address - Fax:
Practice Address - Street 1:206 ALASKA FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-7909
Practice Address - Country:US
Practice Address - Phone:406-414-3334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-29
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-127619363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily