Healthcare Provider Details

I. General information

NPI: 1679833016
Provider Name (Legal Business Name): MARK AARON ACKERMAN RN, APN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2012
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 W MENDENHALL ST STE 202
BOZEMAN MT
59715-3566
US

IV. Provider business mailing address

96 N WEAVER ST UNIT 440
BELGRADE MT
59714-7018
US

V. Phone/Fax

Practice location:
  • Phone: 406-219-7233
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN001375
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP7767
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number76856
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: