Healthcare Provider Details

I. General information

NPI: 1144261207
Provider Name (Legal Business Name): BONNY JO BARR PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 MLK JR BLVD
EUGENE OR
97401-5824
US

IV. Provider business mailing address

2885 STARK ST
EUGENE OR
97404-1891
US

V. Phone/Fax

Practice location:
  • Phone: 541-682-3608
  • Fax: 541-682-7598
Mailing address:
  • Phone: 541-689-8032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number083041959N6 PMHNP PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: