=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003917618
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER LEE BRUNSDON MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2006
-----------------------------------------------------
Last Update Date | 10/28/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16 W MAIN ST
-----------------------------------------------------
City | WHITE SULPHUR SPRINGS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59645-9036
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-547-3321
-----------------------------------------------------
Fax | 406-547-3298
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 906 DEARBORN AVE
-----------------------------------------------------
City | HELENA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59601-2756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-461-5796
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 10721
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------