Healthcare Provider Details

I. General information

NPI: 1295882694
Provider Name (Legal Business Name): BONNIE A LYNAM RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E CHURCH ST
SANTA MARIA CA
93454-5906
US

IV. Provider business mailing address

400 EMERALD BAY DR
ARROYO GRANDE CA
93420-2683
US

V. Phone/Fax

Practice location:
  • Phone: 805-739-3000
  • Fax:
Mailing address:
  • Phone: 805-481-0304
  • Fax: 805-481-0304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number247396
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: