Provider Demographics
NPI:1346452240
Name:BONO, LINDA M (FNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:BONO
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 1:1010 1ST ST SE STE 110
Mailing Address - Street 2:
Mailing Address - City:BANDON
Mailing Address - State:OR
Mailing Address - Zip Code:97411-9301
Mailing Address - Country:US
Mailing Address - Phone:541-347-2529
Mailing Address - Fax:
Practice Address - Street 1:1312 TICHENOR ST
Practice Address - Street 2:
Practice Address - City:PORT ORFORD
Practice Address - State:OR
Practice Address - Zip Code:97465-8776
Practice Address - Country:US
Practice Address - Phone:541-640-7625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15622363LP2300X
WI2401-033363LF0000X
FL1529912363LF0000X
OR201708457NP-PP363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL660209600OtherMEDICAID GROUP
FLE6906YOtherMEDICARE PROVIDER
FL304224300Medicaid
FL35207UOtherMEDICARE GROUP
FL542078370OtherCLARK CLINIC, INC
FLE6906YOtherMEDICARE PROVIDER
FLE6906ZMedicare PIN