Healthcare Provider Details

I. General information

NPI: 1659695443
Provider Name (Legal Business Name): BONNIE MCGOWAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2010
Last Update Date: 03/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3687 VETERANS DR PATIENT CARE SERVICES/ NURSING (118)
FORT HARRISON MT
59636-9703
US

IV. Provider business mailing address

1021 REDPOLL LOOP
HELENA MT
59602-0545
US

V. Phone/Fax

Practice location:
  • Phone: 406-447-7019
  • Fax: 406-447-7968
Mailing address:
  • Phone: 805-680-0003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number665787
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: