Healthcare Provider Details

I. General information

NPI: 1649335928
Provider Name (Legal Business Name): DELYNA RAE BOHNENBLUST ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 N 32ND STREET
ATTAMONT KS
67330
US

IV. Provider business mailing address

509 N 32ND STREET
ATTAMONT KS
67330
US

V. Phone/Fax

Practice location:
  • Phone: 620-784-5562
  • Fax:
Mailing address:
  • Phone: 620-784-5562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number74052
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: