Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | MD188655 | OR |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | MED-PHYS-LIC-94803 | MT |
NPI | 1316364276 |
---|---|
Provider Name | Mrs. Alaina Town Bennett |
First Address | Bozeman, MT 59715-6903 |
Second Address | Bozeman, MT 59715-6903 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2014 |
Last Update Date | 19/10/2021 |