Provider Demographics
NPI:1407200660
Name:BISSONETTE, STEFANI (MD)
Entity type:Individual
Prefix:
First Name:STEFANI
Middle Name:
Last Name:BISSONETTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:WY
Mailing Address - Zip Code:82633-2446
Mailing Address - Country:US
Mailing Address - Phone:307-358-7300
Mailing Address - Fax:
Practice Address - Street 1:700 E CENTER ST
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:WY
Practice Address - Zip Code:82633-2446
Practice Address - Country:US
Practice Address - Phone:307-358-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-14
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY13011A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology