Healthcare Provider Details

I. General information

NPI: 1962805267
Provider Name (Legal Business Name): BONNIE CHAN RPYT, CNA, LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2014
Last Update Date: 09/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 N 74TH ST
SEATTLE WA
98103-5010
US

IV. Provider business mailing address

149 N 74TH ST
SEATTLE WA
98103-5010
US

V. Phone/Fax

Practice location:
  • Phone: 206-383-0686
  • Fax:
Mailing address:
  • Phone: 206-383-0686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60269416
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberNC60499700
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: