Basic Information
| Provider Information | |||||||||
| NPI: | 1134212277 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOUHY-THURSTON | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | KAY | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 403 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BELGRADE | ||||||||
| State: | MT | ||||||||
| PostalCode: | 597143401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4063888708 | ||||||||
| FaxNumber: | 4063888710 | ||||||||
| Practice Location | |||||||||
| Address1: | 403 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BELGRADE | ||||||||
| State: | MT | ||||||||
| PostalCode: | 597143401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4063888708 | ||||||||
| FaxNumber: | 4063888710 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 07/03/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | RN9447 | MT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 4308344 | 05 | MT | MEDICAID | 810542541 | 01 | MT | COMMERCIAL | OTHER |