Individual
MARCIE RENEE LOVGREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1450 ELLIS ST, SUITE 201, BOZEMAN, MT 59715-8812
(406) 587-0122
Mailing address
1450 ELLIS ST, SUITE 201, BOZEMAN, MT 59715-8812
(406) 587-0122
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
509
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
509
MT LICENSE NUMBER
MT
Enumeration date
09/12/2007
Last updated
09/12/2007
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