Healthcare Provider Details

I. General information

NPI: 1508400607
Provider Name (Legal Business Name): ABIGAIL BANMBUH PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2019
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 N MAIN ST BOZEMAN
BOZEMAN MT
59715
US

IV. Provider business mailing address

233 N MAIN ST BOZEMAN
BOZEMAN MT
59715
US

V. Phone/Fax

Practice location:
  • Phone: 406-296-6494
  • Fax:
Mailing address:
  • Phone: 281-837-6912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number61001
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP143864
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: