Healthcare Provider Details

I. General information

NPI: 1205947819
Provider Name (Legal Business Name): MARION RUTH BACHRA RD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 SHERIDAN AVE
BOZEMAN MT
59718-6283
US

IV. Provider business mailing address

127 SHERIDAN AVE
BOZEMAN MT
59718-6283
US

V. Phone/Fax

Practice location:
  • Phone: 406-586-1833
  • Fax: 406-586-1833
Mailing address:
  • Phone: 406-586-1833
  • Fax: 406-586-1833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number391
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: