Healthcare Provider Details

I. General information

NPI: 1568514438
Provider Name (Legal Business Name): CATHRINE BRENDA BODNAR RD CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 MISSION DRIVE
ST. IGNATIUS MT
59865
US

IV. Provider business mailing address

PO BOX 328
ST. IGNATIUS MT
59865
US

V. Phone/Fax

Practice location:
  • Phone: 406-745-3525
  • Fax: 406-745-4235
Mailing address:
  • Phone: 406-745-3525
  • Fax: 406-745-4235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number855486
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: