Healthcare Provider Details

I. General information

NPI: 1720079643
Provider Name (Legal Business Name): BONNIE MARIE BIRD MS, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 SW COAST HWY STE 203
NEWPORT OR
97365-5215
US

IV. Provider business mailing address

PO BOX 330
NEWPORT OR
97365-0026
US

V. Phone/Fax

Practice location:
  • Phone: 541-265-4947
  • Fax: 541-994-0261
Mailing address:
  • Phone: 541-351-1010
  • Fax: 541-574-7670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200850004 NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: