Healthcare Provider Details

I. General information

NPI: 1972321537
Provider Name (Legal Business Name): ANTHONY ERIC GUMARANG BUZZELL PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2024
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 FORT MISSOULA RD STE 101
MISSOULA MT
59804-7403
US

IV. Provider business mailing address

19507 BRYCE PUTNAM DR
FRENCHTOWN MT
59834-9737
US

V. Phone/Fax

Practice location:
  • Phone: 406-327-4351
  • Fax:
Mailing address:
  • Phone: 619-971-5751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNUR-APRN-LIC-242053
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: