Provider Demographics
NPI:1205947819
Name:BACHRA, MARION RUTH (RD, MS)
Entity type:Individual
Prefix:MS
First Name:MARION
Middle Name:RUTH
Last Name:BACHRA
Suffix:
Gender:F
Credentials:RD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 SHERIDAN AVE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6283
Mailing Address - Country:US
Mailing Address - Phone:406-586-1833
Mailing Address - Fax:406-586-1833
Practice Address - Street 1:127 SHERIDAN AVE
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-6283
Practice Address - Country:US
Practice Address - Phone:406-586-1833
Practice Address - Fax:406-586-1833
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT391133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0280143Medicaid
MT0280143Medicaid