Provider Demographics
NPI:1841441201
Name:BONNER, ANDREW D (ND)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:D
Last Name:BONNER
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 NE HALSEY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1522
Mailing Address - Country:US
Mailing Address - Phone:503-234-7299
Mailing Address - Fax:503-234-9639
Practice Address - Street 1:2121 NE HALSEY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1522
Practice Address - Country:US
Practice Address - Phone:503-234-7299
Practice Address - Fax:503-234-9639
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-03
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0902175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath