Healthcare Provider Details

I. General information

NPI: 1366000515
Provider Name (Legal Business Name): BONNIE OXFORD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2019
Last Update Date: 06/10/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 W 1ST ST
WAPATO WA
98951-1108
US

IV. Provider business mailing address

620 W 1ST ST
WAPATO WA
98951-1108
US

V. Phone/Fax

Practice location:
  • Phone: 509-877-4111
  • Fax:
Mailing address:
  • Phone: 509-877-4111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN-26679
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number140816
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP61534464
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: