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General NPI Number Information
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NPI Number | 1992997027
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Entity Type | Individual
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Provider Name | HEATHER LYNN BONSHOCK FNP-C
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Gender | Female
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Dates
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Enumeration Date | 08/13/2007
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Last Update Date | 08/13/2007
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Provider Practice Location Address
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Address Line | 8200 JONES BRANCH DR WELLNESS CENTER RM.1317 MS111
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City | MC LEAN
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State | VA
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Zip | 22102-3107
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Country | US
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Telephone | 703-903-2844
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Fax | 703-903-2803
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Provider Business Mailing Address
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Address Line | 3196 KINBRACE RD
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City | OAK HILL
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State | VA
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Zip | 20171-3308
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Country | US
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Telephone | 703-961-0306
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024165818
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License Number State | VA
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