Provider Demographics
NPI:1619930914
Name:MCREYNOLDS, BONNIE J (ARNP)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:J
Last Name:MCREYNOLDS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ELMA
Mailing Address - State:WA
Mailing Address - Zip Code:98541-9353
Mailing Address - Country:US
Mailing Address - Phone:360-346-2222
Mailing Address - Fax:360-346-2192
Practice Address - Street 1:600 E. MAIN STREET
Practice Address - Street 2:
Practice Address - City:ELMA
Practice Address - State:WA
Practice Address - Zip Code:98541
Practice Address - Country:US
Practice Address - Phone:360-346-2222
Practice Address - Fax:360-346-2161
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005362363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8100MZOtherREGENCE
WAA009OtherTRICARE
WA1014731Medicaid
WA9628165Medicaid
WA8100MZOtherREGENCE