Healthcare Provider Details

I. General information

NPI: 1194756486
Provider Name (Legal Business Name): BONNIE L NEDROW ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 WELLER ST
PETALUMA CA
94952-3183
US

IV. Provider business mailing address

16890 SWEETWATER SPRINGS RD
GUERNEVILLE CA
95446-9533
US

V. Phone/Fax

Practice location:
  • Phone: 541-283-3038
  • Fax:
Mailing address:
  • Phone: 541-227-9984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1479
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND880
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: