Healthcare Provider Details

I. General information

NPI: 1194017665
Provider Name (Legal Business Name): DR. BONITA J SEUBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BONITA J SEUBERT DNPC FNPC

II. Dates (important events)

Enumeration Date: 05/03/2011
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E 33RD ST STE 206
VANCOUVER WA
98663-2776
US

IV. Provider business mailing address

704 W 31ST ST
VANCOUVER WA
98660-2046
US

V. Phone/Fax

Practice location:
  • Phone: 360-695-1334
  • Fax: 360-992-1159
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number363LF0000X
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: