Healthcare Provider Details

I. General information

NPI: 1285764050
Provider Name (Legal Business Name): PAULA A BONNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 FRANKLIN ST
DENVER CO
80205-5437
US

IV. Provider business mailing address

12710 W 6TH PL
LAKEWOOD CO
80401-4622
US

V. Phone/Fax

Practice location:
  • Phone: 303-861-3302
  • Fax:
Mailing address:
  • Phone: 303-237-3077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number161687
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: