Healthcare Provider Details

I. General information

NPI: 1427150606
Provider Name (Legal Business Name): BONNY M WEED RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 WAINWRIGHT DR VAMC
WALLA WALLA WA
99362-3975
US

IV. Provider business mailing address

77 WAINWRIGHT DR VAMC
WALLA WALLA WA
99362-3975
US

V. Phone/Fax

Practice location:
  • Phone: 509-525-5200
  • Fax: 509-527-6124
Mailing address:
  • Phone: 509-525-5200
  • Fax: 509-527-6124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN00079435
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberR029022
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: