Provider Demographics
NPI:1649335928
Name:BOHNENBLUST, DELYNA RAE (ARNP)
Entity type:Individual
Prefix:
First Name:DELYNA
Middle Name:RAE
Last Name:BOHNENBLUST
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 N 32ND STREET
Mailing Address - Street 2:
Mailing Address - City:ATTAMONT
Mailing Address - State:KS
Mailing Address - Zip Code:67330
Mailing Address - Country:US
Mailing Address - Phone:620-784-5562
Mailing Address - Fax:
Practice Address - Street 1:509 N 32ND STREET
Practice Address - Street 2:
Practice Address - City:ATTAMONT
Practice Address - State:KS
Practice Address - Zip Code:67330
Practice Address - Country:US
Practice Address - Phone:620-784-5562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS74052364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS161305OtherBCBS
KS161305OtherBCBS