Provider Demographics
NPI:1588936892
Name:BURKHOLDER, STEPHANIE BUSWELL (APRN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:BUSWELL
Last Name:BURKHOLDER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N ASTER AVE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6033
Mailing Address - Country:US
Mailing Address - Phone:406-600-4582
Mailing Address - Fax:
Practice Address - Street 1:215 W MENDENHALL ST
Practice Address - Street 2:ROOM 117
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3478
Practice Address - Country:US
Practice Address - Phone:406-582-3106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT35481363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily