Healthcare Provider Details

I. General information

NPI: 1619640091
Provider Name (Legal Business Name): MARA ZELLO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 HIGHLAND BLVD STE 2180
BOZEMAN MT
59715-6904
US

IV. Provider business mailing address

915 HIGHLAND BLVD
BOZEMAN MT
59715-6902
US

V. Phone/Fax

Practice location:
  • Phone: 406-414-5512
  • Fax: 406-414-3610
Mailing address:
  • Phone: 406-414-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNUR-APRN-LIC-175734
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: