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Individual

MALLORY J BUCK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
APRN

Contact information

Practice address
500 W BROADWAY ST STE 320, MISSOULA, MT 59802-4003
(406) 329-5615
Mailing address
PO BOX 12, LIBERTY LAKE, WA 99019-0012
(406) 329-5615
(406) 329-5606

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
113040
NE
363L00000X
Nurse Practitioner
NUR-APRN-LIC-242130
MT
363LG0600X
Gerontology Nurse Practitioner
Primary
NUR-APRN-LIC-242130
MT

Other

Enumeration date
10/21/2016
Last updated
10/30/2024
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