Provider Demographics
NPI:1770244030
Name:BONTRAGER, BERNITA (NIC)
Entity Type:Individual
Prefix:
First Name:BERNITA
Middle Name:
Last Name:BONTRAGER
Suffix:
Gender:F
Credentials:NIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6914 S 12TH ST APT 1405
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98465-1717
Mailing Address - Country:US
Mailing Address - Phone:425-343-4357
Mailing Address - Fax:
Practice Address - Street 1:6914 S 12TH ST APT 1405
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98465-1717
Practice Address - Country:US
Practice Address - Phone:425-343-4357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA89599171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter