Provider Demographics
NPI:1194017665
Name:SEUBERT, BONITA J
Entity Type:Individual
Prefix:DR
First Name:BONITA
Middle Name:J
Last Name:SEUBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:BONITA
Other - Middle Name:J
Other - Last Name:SEUBERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNPC FNPC
Mailing Address - Street 1:704 W 31ST ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-2046
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 E 33RD ST
Practice Address - Street 2:STE 206
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-2776
Practice Address - Country:US
Practice Address - Phone:360-695-1334
Practice Address - Fax:360-992-1159
Is Sole Proprietor?:No
Enumeration Date:2011-05-03
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR363LF0000X363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily