Provider Demographics
NPI:1245561943
Name:BONEBRAKE, GLORYANN
Entity Type:Individual
Prefix:MRS
First Name:GLORYANN
Middle Name:
Last Name:BONEBRAKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6704 NE 199TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-1752
Mailing Address - Country:US
Mailing Address - Phone:360-574-1820
Mailing Address - Fax:
Practice Address - Street 1:6704 NE 199TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-1752
Practice Address - Country:US
Practice Address - Phone:360-574-1820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant