Doctor Name: | MR. RICHARD BOHNEMANN |
NPI Number: | 1194743179 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | PA10002317 |
Business Practice Address: | 6013 87th Ave W University Place, WA - 984671611 |
Business Phone Number: | 2535655972 |
Business Fax Number: | |
Mailing Address: | 6013 87th Ave W, UNIVERSITY PLACE |
State: | WA |
Postal Code: | 984671611 |
Phone Number: | 2535655972 |
Fax Number: | |
NPI Enumeration Date: | 07/17/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | PA10002317 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |