Individual
LOGEN ROSS NUNBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
105 E OAK ST STE 1E, BOZEMAN, MT 59715-2978
(406) 404-1350
Mailing address
105 E OAK ST STE 1E, BOZEMAN, MT 59715-2978
(406) 404-1350
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
NUR-APRN-LIC-146080
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NUR-APRN-LIC-146080
STATE LICENSE
MT
Enumeration date
08/01/2019
Last updated
08/01/2019
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