Healthcare Provider Details

I. General information

NPI: 1164687141
Provider Name (Legal Business Name): BARBARA ANN BONHAM R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 07/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 W HIGHWAY 98
PENSACOLA FL
32512-0001
US

IV. Provider business mailing address

4804 EASY ST
ORANGE BEACH AL
36561-3893
US

V. Phone/Fax

Practice location:
  • Phone: 850-505-6277
  • Fax:
Mailing address:
  • Phone: 251-981-7670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0100X
TaxonomyGastroenterology Registered Nurse
License Number9209874
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: