Healthcare Provider Details

I. General information

NPI: 1235307737
Provider Name (Legal Business Name): BONNIE A LASH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1344 WINTERGREEN LANE STE 100
BAINBRIDGE ISLAND WA
98110
US

IV. Provider business mailing address

1344 WINTERGREEN LANE STE 100
BAINBRIDGE ISLAND WA
98110
US

V. Phone/Fax

Practice location:
  • Phone: 206-201-0488
  • Fax: 206-201-0490
Mailing address:
  • Phone: 206-201-0488
  • Fax: 206-201-0490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1277
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60462750
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: