Healthcare Provider Details

I. General information

NPI: 1538478078
Provider Name (Legal Business Name): ELIZABETH AXELROD STEGMAIER N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2010
Last Update Date: 01/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2204 DIXON AVE BLACK BEAR NATUROPATHIC CLINIC
MISSOULA MT
59801-8224
US

IV. Provider business mailing address

2204 DIXON AVE BLACK BEAR NATUROPATHIC CLINIC
MISSOULA MT
59801-8224
US

V. Phone/Fax

Practice location:
  • Phone: 406-542-2147
  • Fax:
Mailing address:
  • Phone: 406-542-2147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number806
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: