Provider Demographics
NPI:1306041090
Name:RYDING, BONNIE R (ARNP)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:R
Last Name:RYDING
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:R
Other - Last Name:WILLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:413 LILLY RD NE
Mailing Address - Street 2:EMPLOYEE HEALTH AND WELLNESS
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5133
Mailing Address - Country:US
Mailing Address - Phone:360-493-7825
Mailing Address - Fax:360-493-5398
Practice Address - Street 1:413 LILLY RD NE
Practice Address - Street 2:EMPLOYEE HEALTH AND WELLNESS
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5133
Practice Address - Country:US
Practice Address - Phone:360-493-7825
Practice Address - Fax:360-493-5398
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006095363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0160723OtherL&I
WAAP30006095OtherARNP
WARN00053231OtherRN