Healthcare Provider Details

I. General information

NPI: 1891129029
Provider Name (Legal Business Name): SHANNAN ZELL BOGNER BHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNAN ZELL BHT

II. Dates (important events)

Enumeration Date: 08/23/2013
Last Update Date: 08/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 N 24TH ST
PHOENIX AZ
85016-6512
US

IV. Provider business mailing address

795 SUNSET BLVD SUITE F
KALISPELL MT
59901-3699
US

V. Phone/Fax

Practice location:
  • Phone: 602-955-7997
  • Fax: 602-954-0980
Mailing address:
  • Phone: 406-260-4181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: