Provider Demographics
NPI:1235307737
Name:LASH, BONNIE A (FNP)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:A
Last Name:LASH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3412 GLACIER HWY
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-9501
Mailing Address - Country:US
Mailing Address - Phone:907-465-3353
Mailing Address - Fax:907-465-3389
Practice Address - Street 1:3412 GLACIER HWY
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-9501
Practice Address - Country:US
Practice Address - Phone:907-465-3353
Practice Address - Fax:907-465-3389
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF335268207Q00000X
AK1277363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00903700Medicaid
NY00903700Medicaid