Provider Demographics
NPI:1265781827
Name:YATES, BONNIE DOLORES (CPNP-AC)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:DOLORES
Last Name:YATES
Suffix:
Gender:F
Credentials:CPNP-AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 ROCKVILLE PIKE BLDG 10
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20892-0001
Mailing Address - Country:US
Mailing Address - Phone:240-760-6204
Mailing Address - Fax:301-482-5157
Practice Address - Street 1:9000 ROCKVILLE PIKE BLDG 10
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892
Practice Address - Country:US
Practice Address - Phone:240-760-6204
Practice Address - Fax:301-482-5157
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC002408363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics