Healthcare Provider Details

I. General information

NPI: 1396832846
Provider Name (Legal Business Name): BONNIE ELIZABETH STEPHENS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 09/20/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2827 FORT MISSOULA RD
MISSOULA MT
59804
US

IV. Provider business mailing address

2827 FORT MISSOULA RD
MISSOULA MT
59804
US

V. Phone/Fax

Practice location:
  • Phone: 406-327-4002
  • Fax: 208-625-5728
Mailing address:
  • Phone: 406-327-4002
  • Fax: 208-625-5731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberM12543
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: