Provider Demographics
NPI:1952119976
Name:O'MARA, BONNIE SKARLETT
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:SKARLETT
Last Name:O'MARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8301 NE HAZEL DELL AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-8047
Mailing Address - Country:US
Mailing Address - Phone:360-977-6090
Mailing Address - Fax:360-836-5659
Practice Address - Street 1:8301 NE HAZEL DELL AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-8047
Practice Address - Country:US
Practice Address - Phone:360-977-6090
Practice Address - Fax:360-836-5659
Is Sole Proprietor?:No
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60213174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist