Healthcare Provider Details

I. General information

NPI: 1629309638
Provider Name (Legal Business Name): SHARON G BONOGOFSKY-PARKER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2010
Last Update Date: 01/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2321 BROADWATER AVE
BILLINGS MT
59102-4715
US

IV. Provider business mailing address

2321 BROADWATER AVE
BILLINGS MT
59102-4715
US

V. Phone/Fax

Practice location:
  • Phone: 406-652-4868
  • Fax: 406-652-2373
Mailing address:
  • Phone: 406-652-4868
  • Fax: 406-652-2373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SW0102X
TaxonomyWomen's Health Clinical Nurse Specialist
License Number9889
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: