Provider Demographics
NPI:1104998103
Name:BON, ROBIN A (NP)
Entity type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:A
Last Name:BON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:ROBIN
Other - Middle Name:BON
Other - Last Name:FREDERICKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:1425 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5318
Mailing Address - Country:US
Mailing Address - Phone:925-295-6820
Mailing Address - Fax:925-295-6844
Practice Address - Street 1:1425 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5318
Practice Address - Country:US
Practice Address - Phone:925-295-6820
Practice Address - Fax:925-295-6844
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA351839363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ13742Medicare UPIN