Provider Demographics
NPI:1093044968
Name:BONVILLE, ALISUN CUMMINGS (ND)
Entity Type:Individual
Prefix:DR
First Name:ALISUN
Middle Name:CUMMINGS
Last Name:BONVILLE
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10651
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59719-0651
Mailing Address - Country:US
Mailing Address - Phone:503-853-5273
Mailing Address - Fax:406-586-2676
Practice Address - Street 1:962 STONERIDGE DR STE 2
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-7083
Practice Address - Country:US
Practice Address - Phone:406-586-2626
Practice Address - Fax:406-586-2676
Is Sole Proprietor?:No
Enumeration Date:2009-12-23
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1711175F00000X
MTAHC-NAT-LIC-801175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath