Provider Demographics
NPI:1790726115
Name:BOND-DESCHAMPS, JOAN MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:MARIE
Last Name:BOND-DESCHAMPS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:JOAN
Other - Middle Name:MARIE
Other - Last Name:BOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2360 MULLAN RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1811
Mailing Address - Country:US
Mailing Address - Phone:406-721-4436
Mailing Address - Fax:406-721-6053
Practice Address - Street 1:2360 MULLAN RD
Practice Address - Street 2:SUITE C
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1811
Practice Address - Country:US
Practice Address - Phone:406-721-4436
Practice Address - Fax:406-721-6053
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT241363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT4303737Medicaid
MTP25100Medicare UPIN
MT4303737Medicaid