Provider Demographics
NPI:1770791667
Name:CAREY, BONNIE (LAC,OMD)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:CAREY
Suffix:
Gender:F
Credentials:LAC,OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 MCDOUGALL RD W
Mailing Address - Street 2:
Mailing Address - City:MOSSYROCK
Mailing Address - State:WA
Mailing Address - Zip Code:98564-9416
Mailing Address - Country:US
Mailing Address - Phone:360-983-8594
Mailing Address - Fax:
Practice Address - Street 1:242 E STATE ST
Practice Address - Street 2:
Practice Address - City:MOSSYROCK
Practice Address - State:WA
Practice Address - Zip Code:98564
Practice Address - Country:US
Practice Address - Phone:360-983-8594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA622171100000X
CT10171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist