Organization
WELLSPRING HEALTH AND AESTHETICS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHANIE SUPRENANT MD (PLASTIC AND RECONSTRUCTIVE SURGEON)
(406) 370-1600
Entity
Organization
Contact information
Practice address
500 W BROADWAY ST FL 4, MISSOULA, MT 59802-4008
(406) 370-1600
(406) 493-0333
Mailing address
122 DALY AVE, MISSOULA, MT 59801-4212
(815) 482-9859
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
—
—
2082S0099X
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
—
—
2082S0105X
Surgery of the Hand (Plastic Surgery) Physician
—
—
2086S0122X
Plastic and Reconstructive Surgery Physician
—
—
Other
Enumeration date
06/15/2023
Last updated
10/06/2023
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