Healthcare Provider Details

I. General information

NPI: 1174015234
Provider Name (Legal Business Name): EMILY ELIZABETH TRUONG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY ELIZABETH HARRIS

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3905 WELLNESS WAY
BOZEMAN MT
59718-2402
US

IV. Provider business mailing address

1505 WESTLAKE AVE N STE 400
SEATTLE WA
98109-6211
US

V. Phone/Fax

Practice location:
  • Phone: 406-898-1200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.PA.61320442
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA57286
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMED-PAC-LIC-175546
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: