Individual
MS. MARA CHRISTINE LIMONCELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1006 W MAIN ST, BOZEMAN, MT 59715-3219
(406) 414-4800
Mailing address
915 HIGHLAND BLVD, BOZEMAN, MT 59715-6902
(406) 414-5000
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
PA158092
OR
363A00000X
Physician Assistant
Primary
MED-PAC-LIC-104134
MT
363A00000X
Physician Assistant
PA158092
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500705178
—
OR
Enumeration date
04/17/2011
Last updated
04/10/2025
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