MEDICARE: BONNIE LENYARD PMHNP-BC, FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	TAP5663	AZ
2	363LF0000X	Family Nurse Practitioner	TAP5663	AZ
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	TAP5663	AZ

General Provider Information

NPI Number	:	1053726794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONNIE LENYARD PMHNP-BC, FNP-BC

Provider Business Mailing Address
First Line	:	8433 N BLACK CANYON HWY STE 100-18
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-4873
Country	:	US
Telephone Number	:	602-228-0045
Fax Number	:	602-560-8336

Provider Business Practice Location Address
First Line	:	8433 N BLACK CANYON HWY STE 100-18
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-4873
Country	:	US
Telephone Number	:	602-228-0045
Fax Number	:	602-560-8336

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2014
Last Update Date	:	01/17/2025

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