Provider Demographics
NPI:1659933075
Name:BOBO, BONA (APRN)
Entity Type:Individual
Prefix:
First Name:BONA
Middle Name:
Last Name:BOBO
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 SE HEARTHWOOD BLVD # 873933
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-7551
Mailing Address - Country:US
Mailing Address - Phone:702-849-3302
Mailing Address - Fax:778-769-4717
Practice Address - Street 1:304 SE HEARTHWOOD BLVD # 873933
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-7551
Practice Address - Country:US
Practice Address - Phone:702-849-3302
Practice Address - Fax:778-769-4717
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV822801363LG0600X, 363LA2200X
COAPN.0994746-NP363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COAPN.0994746-NPOtherAPN