Healthcare Provider Details

I. General information

NPI: 1932733664
Provider Name (Legal Business Name): BONNIE SOUSER CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BONNIE SHAFFER CNS

II. Dates (important events)

Enumeration Date: 03/03/2020
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2635 N 7TH ST
GRAND JUNCTION CO
81501-8209
US

IV. Provider business mailing address

475 N SUN CT
GRAND JUNCTION CO
81504-6345
US

V. Phone/Fax

Practice location:
  • Phone: 970-298-2273
  • Fax:
Mailing address:
  • Phone: 720-601-8986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SX0200X
TaxonomyOncology Clinical Nurse Specialist
License Number0017009
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: