Provider Demographics
NPI:1669597191
Name:FORD, BONNIE F (NP)
Entity type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:F
Last Name:FORD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7650
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23231-0150
Mailing Address - Country:US
Mailing Address - Phone:804-507-1644
Mailing Address - Fax:804-507-0116
Practice Address - Street 1:2000 BREMO RD
Practice Address - Street 2:SUITE 205
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-2440
Practice Address - Country:US
Practice Address - Phone:804-523-3712
Practice Address - Fax:804-523-7736
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024034660363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006258506Medicaid
VAC09646OtherGROUP MEDICARE NUMBER