Healthcare Provider Details

I. General information

NPI: 1821013160
Provider Name (Legal Business Name): CYNTHIA ROWE BACON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 HIGHLAND BLVD STE 3130
BOZEMAN MT
59715-6914
US

IV. Provider business mailing address

915 HIGHLAND BLVD
BOZEMAN MT
59715-6902
US

V. Phone/Fax

Practice location:
  • Phone: 406-414-5070
  • Fax:
Mailing address:
  • Phone: 406-414-1044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2005010399-22
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNUR-APRN-LIC-160035
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number05-01633
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: