Healthcare Provider Details

I. General information

NPI: 1144082652
Provider Name (Legal Business Name): BONNIE JEAN DAY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4690 HOEN AVE
SANTA ROSA CA
95405-7823
US

IV. Provider business mailing address

4690 HOEN AVE
SANTA ROSA CA
95405-7823
US

V. Phone/Fax

Practice location:
  • Phone: 707-575-5831
  • Fax: 707-575-4379
Mailing address:
  • Phone: 707-575-5831
  • Fax: 707-575-4379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number444910
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: