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General NPI Number Information
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NPI Number | 1659933075
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Entity Type | Individual
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Provider Name | BONA BOBO APRN
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Gender | Male
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Dates
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Enumeration Date | 07/05/2019
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Last Update Date | 12/05/2023
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Provider Practice Location Address
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Address Line | 304 SE HEARTHWOOD BLVD # 873933
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City | VANCOUVER
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State | WA
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Zip | 98684-7551
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Country | US
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Telephone | 702-849-3302
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Fax | 778-769-4717
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Provider Business Mailing Address
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Address Line | 304 SE HEARTHWOOD BLVD # 873933
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City | VANCOUVER
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State | WA
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Zip | 98684-7551
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Country | US
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Telephone | 702-849-3302
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Fax | 778-769-4717
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 822801
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | APN.0994746-NP
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 822801
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License Number State | NV
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Taxonomy #4
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | APN.0994746-NP
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License Number State | CO
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