Healthcare Provider Details

I. General information

NPI: 1275525008
Provider Name (Legal Business Name): BONNIE LYNN BURNQUIST MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 11/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 ATLANTIC AVE SUITE201
OCEAN VIEW DE
19970-9163
US

IV. Provider business mailing address

71 OMEGA DR BUILDING D
NEWARK DE
19713-2063
US

V. Phone/Fax

Practice location:
  • Phone: 302-537-6110
  • Fax: 302-537-4666
Mailing address:
  • Phone: 302-283-3300
  • Fax: 302-283-3321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC10007200
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: