Provider Demographics
NPI:1720604929
Name:TRYSTIANSON, BOWEN AUSTIN STEPHEN (DNP)
Entity Type:Individual
Prefix:
First Name:BOWEN
Middle Name:AUSTIN STEPHEN
Last Name:TRYSTIANSON
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 RIVERVIEW 1 E
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-1528
Mailing Address - Country:US
Mailing Address - Phone:406-836-0362
Mailing Address - Fax:
Practice Address - Street 1:1400 29TH ST S STE 220
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-5315
Practice Address - Country:US
Practice Address - Phone:406-350-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-197059363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner