Healthcare Provider Details

I. General information

NPI: 1922604693
Provider Name (Legal Business Name): OHANA PROVIDERS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2020
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N HIGGINS AVE STE 600
MISSOULA MT
59802-4494
US

IV. Provider business mailing address

111 N HIGGINS AVE STE 600/ P.O. BOX 4747
MISSOULA MT
59802-4494
US

V. Phone/Fax

Practice location:
  • Phone: 206-406-6729
  • Fax:
Mailing address:
  • Phone: 206-406-6729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHELSEA BODNAR
Title or Position: MANAGER
Credential:
Phone: 406-290-9769