Provider Demographics
NPI:1073633533
Name:KASER, BRENDA A (LAC)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:A
Last Name:KASER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:A
Other - Last Name:CHAMILLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:300 N WILLSON AVE
Mailing Address - Street 2:SUITE 805H
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-3551
Mailing Address - Country:US
Mailing Address - Phone:406-556-8649
Mailing Address - Fax:
Practice Address - Street 1:300 N WILLSON AVE
Practice Address - Street 2:SUITE 805H
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3551
Practice Address - Country:US
Practice Address - Phone:406-556-8649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT143171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist