Provider Demographics
NPI:1710079777
Name:DARRELL, BONNIE JAY (CNP)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:JAY
Last Name:DARRELL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 WATERLOO ST
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-2708
Mailing Address - Country:US
Mailing Address - Phone:540-349-1474
Mailing Address - Fax:
Practice Address - Street 1:330 HOSPITAL DR.
Practice Address - Street 2:FAUQUIER CO. HEALTH DEPARTMENT
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186
Practice Address - Country:US
Practice Address - Phone:540-347-6400
Practice Address - Fax:540-347-6405
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024055752363LA2200X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Not Answered363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP22312Medicare UPIN