Provider Demographics
NPI:1043882699
Name:BUZZELL, EMERALD NOELLE (FNP)
Entity Type:Individual
Prefix:
First Name:EMERALD
Middle Name:NOELLE
Last Name:BUZZELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 RADIO WAY
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1385
Mailing Address - Country:US
Mailing Address - Phone:406-541-6900
Mailing Address - Fax:406-541-6901
Practice Address - Street 1:3031 RUSSELL ST.
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-8523
Practice Address - Country:US
Practice Address - Phone:406-728-5841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-176635207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTNUR-APRN-LIC-176635OtherNURSE PRACTITIONER LICENSE NUMBER
F03211176OtherAANP FAMILY NURSE PRACTITIONER CERTIFICATION