Healthcare Provider Details

I. General information

NPI: 1043882699
Provider Name (Legal Business Name): EMERALD NOELLE BUZZELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2021
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3031 RUSSELL ST.
MISSOULA MT
59801-8523
US

IV. Provider business mailing address

2700 RADIO WAY
MISSOULA MT
59808-1385
US

V. Phone/Fax

Practice location:
  • Phone: 406-728-5841
  • Fax:
Mailing address:
  • Phone: 406-541-6900
  • Fax: 406-541-6901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberNUR-APRN-LIC-176635
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNUR-APRN-LIC-176635
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: