Provider Information for 1962033605
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CHELCI MARIE BRUNO
Sex: Female
NPI: 1962033605
Last Updated: 2020-01-31
Certification Date: 2020-01-31
Certification Date: 2020-01-31
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1962033605 | ||||||||
| Enumeration Date | 2020-01-31 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1234 1/2 PHILLIPS ST MISSOULA, MT 59802-2325 United States Phone: 406-360-1047 | Fax: | ||||||||
| Primary Practice Address | 2423 MULLAN RD MISSOULA, MT 59808-1827 United States Phone: 406-360-1047 | Fax:406-830-3156 | ||||||||
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