Healthcare Provider Details

I. General information

NPI: 1154597441
Provider Name (Legal Business Name): BONNYLIN LINDQUIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 LIBBIE AVE SUITE 4
RICHMOND VA
23226-2659
US

IV. Provider business mailing address

412 LIBBIE AVE SUITE 4
RICHMOND VA
23226-2659
US

V. Phone/Fax

Practice location:
  • Phone: 804-282-8082
  • Fax: 804-282-9082
Mailing address:
  • Phone: 804-282-8082
  • Fax: 804-282-9082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number0024073897
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: