Provider Demographics
NPI:1386663656
Name:HANSEN, JULIET C (MD)
Entity Type:Individual
Prefix:
First Name:JULIET
Middle Name:C
Last Name:HANSEN
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 1:935 HIGHLAND BLVD
Mailing Address - Street 2:SUITE 4400
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6904
Mailing Address - Country:US
Mailing Address - Phone:406-587-5123
Mailing Address - Fax:406-556-6758
Practice Address - Street 1:937 HIGHLAND BLVD STE 5320
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6916
Practice Address - Country:US
Practice Address - Phone:406-414-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT6353208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT78741Medicaid
MT97250OtherBCBS
MT97250OtherBCBS
MT9725Medicare ID - Type Unspecified