Provider Demographics
NPI:1376594093
Name:BELLINGHAM FAMILY AND WOMEN'S HEALTH
Entity Type:Organization
Organization Name:BELLINGHAM FAMILY AND WOMEN'S HEALTH
Other - Org Name:BELLINGHAM HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SPRAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:360-756-9793
Mailing Address - Street 1:1050 LARRABEE AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-7367
Mailing Address - Country:US
Mailing Address - Phone:360-756-9793
Mailing Address - Fax:360-752-9007
Practice Address - Street 1:1116 KEY ST
Practice Address - Street 2:STE 106
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5232
Practice Address - Country:US
Practice Address - Phone:360-756-9793
Practice Address - Fax:360-752-9007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30001197363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA602-453-320OtherUBI ST. OF WA
WA50D0963661OtherCLIA #
WA9646357Medicaid
WAMTS- 3639OtherCLIA LICENSE #
WA9646357Medicaid
WA50D0963661OtherCLIA #