Provider Demographics
NPI:1003917618
Name:BRUNSDON, JENNIFER LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LEE
Last Name:BRUNSDON
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 1:906 DEARBORN AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-2756
Mailing Address - Country:US
Mailing Address - Phone:406-461-5796
Mailing Address - Fax:
Practice Address - Street 1:16 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITE SULPHUR SPRINGS
Practice Address - State:MT
Practice Address - Zip Code:59645-9036
Practice Address - Country:US
Practice Address - Phone:406-547-3321
Practice Address - Fax:406-547-3298
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10721207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0141908Medicaid
MT99656OtherBCBS OF MT
MT0141908Medicaid