Provider Demographics
NPI:1558794255
Name:TAMENRENG, BONNIE LYNN
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:LYNN
Last Name:TAMENRENG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:LYNN
Other - Last Name:WORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1975 MCPHERSON ST STE 2
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-3482
Mailing Address - Country:US
Mailing Address - Phone:541-751-2500
Mailing Address - Fax:541-751-2661
Practice Address - Street 1:1975 MCPHERSON ST STE 2
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-3482
Practice Address - Country:US
Practice Address - Phone:541-751-2500
Practice Address - Fax:541-751-2661
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator