Provider Demographics
NPI:1730105859
Name:BONHAM, RHAELYNN (NP)
Entity Type:Individual
Prefix:
First Name:RHAELYNN
Middle Name:
Last Name:BONHAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4659
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93403-4659
Mailing Address - Country:US
Mailing Address - Phone:805-597-8386
Mailing Address - Fax:805-592-2392
Practice Address - Street 1:10 SANTA ROSA ST STE 201
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-5825
Practice Address - Country:US
Practice Address - Phone:805-597-8386
Practice Address - Fax:805-592-2392
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA602764163WP1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP1700XNursing Service ProvidersRegistered NursePerinatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
P82950Medicare UPIN