Provider Demographics
NPI:1598536443
Name:GARCIA, BONNIE LYNN (RN IBCLC)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:LYNN
Last Name:GARCIA
Suffix:
Gender:F
Credentials:RN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16830 NORTHGATE DR UNIT 150
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-5778
Mailing Address - Country:US
Mailing Address - Phone:303-805-7879
Mailing Address - Fax:303-805-8076
Practice Address - Street 1:16830 NORTHGATE DR UNIT 150
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-5778
Practice Address - Country:US
Practice Address - Phone:303-805-7879
Practice Address - Fax:303-805-8076
Is Sole Proprietor?:No
Enumeration Date:2024-01-10
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN0083280163W00000X
COL-151901163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse