Provider Demographics
NPI:1912140773
Name:BEND, BONNIE (MT)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:BEND
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2318 TANGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-1953
Mailing Address - Country:US
Mailing Address - Phone:970-482-6678
Mailing Address - Fax:
Practice Address - Street 1:3938 JOHN F KENNEDY PKWY
Practice Address - Street 2:SUITE F-11
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3086
Practice Address - Country:US
Practice Address - Phone:970-204-0516
Practice Address - Fax:970-204-6812
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist