Provider Demographics
NPI:1659331791
Name:SPRAGUE, BONNIE LYNN (ARNP)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:LYNN
Last Name:SPRAGUE
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 1:1116 KEY ST
Mailing Address - Street 2:STE 106
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-5251
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
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00069900163W00000X
WAAP30001197363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9625534Medicaid
WA50D0963661OtherCLIA
WA50D0963661OtherCLIA
WA50D0963661OtherCLIA
WAS87510Medicare UPIN