Healthcare Provider Details

I. General information

NPI: 1003917618
Provider Name (Legal Business Name): JENNIFER LEE BRUNSDON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 W MAIN ST
WHITE SULPHUR SPRINGS MT
59645-9036
US

IV. Provider business mailing address

906 DEARBORN AVE
HELENA MT
59601-2756
US

V. Phone/Fax

Practice location:
  • Phone: 406-547-3321
  • Fax: 406-547-3298
Mailing address:
  • Phone: 406-461-5796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10721
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: