Healthcare Provider Details

I. General information

NPI: 1386233617
Provider Name (Legal Business Name): PAULINE ANNA BUERHAUS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2021
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 SKY CREST DR
BOZEMAN MT
59715-7720
US

IV. Provider business mailing address

285 SKY CREST DR
BOZEMAN MT
59715-7720
US

V. Phone/Fax

Practice location:
  • Phone: 406-224-8425
  • Fax:
Mailing address:
  • Phone: 406-224-8425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number173097
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: