Provider Demographics
NPI:1437592573
Name:CROUTHAMEL, BONNIE CATHERINE
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:CATHERINE
Last Name:CROUTHAMEL
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:PO BOX 9787
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98909-0787
Mailing Address - Country:US
Mailing Address - Phone:509-248-3440
Mailing Address - Fax:509-249-4460
Practice Address - Street 1:3003 TIETON DR STE 230
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3684
Practice Address - Country:US
Practice Address - Phone:092-483-4405
Practice Address - Fax:509-249-4460
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA147919207V00000X
WAMD60952541207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology