Provider Demographics
NPI:1194756486
Name:NEDROW, BONNIE L (ND)
Entity type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:L
Last Name:NEDROW
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16890 SWEETWATER SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:GUERNEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95446-9533
Mailing Address - Country:US
Mailing Address - Phone:541-227-9984
Mailing Address - Fax:
Practice Address - Street 1:222 WELLER ST
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-3183
Practice Address - Country:US
Practice Address - Phone:541-283-3038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1479175F00000X
CAND880175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR241798Medicaid