Provider Demographics
NPI:1508421926
Name:BONTRAGER, S. STAR
Entity Type:Individual
Prefix:
First Name:S. STAR
Middle Name:
Last Name:BONTRAGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHANNA
Other - Middle Name:STAR
Other - Last Name:BONTRAGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPM
Mailing Address - Street 1:28029 WHITE ST
Mailing Address - Street 2:
Mailing Address - City:CASSOPOLIS
Mailing Address - State:MI
Mailing Address - Zip Code:49031-8811
Mailing Address - Country:US
Mailing Address - Phone:574-248-2485
Mailing Address - Fax:267-375-1388
Practice Address - Street 1:28029 WHITE ST
Practice Address - Street 2:
Practice Address - City:CASSOPOLIS
Practice Address - State:MI
Practice Address - Zip Code:49031-8811
Practice Address - Country:US
Practice Address - Phone:574-248-2485
Practice Address - Fax:267-375-1388
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife