Provider Demographics
NPI:1316072200
Name:WICK, BONNIE LYNN (ND)
Entity type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:LYNN
Last Name:WICK
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 1:18816 N 52ND AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-4900
Mailing Address - Country:US
Mailing Address - Phone:623-581-8939
Mailing Address - Fax:480-832-5216
Practice Address - Street 1:4323 E BROADWAY RD
Practice Address - Street 2:STE 109
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3506
Practice Address - Country:US
Practice Address - Phone:480-832-3014
Practice Address - Fax:480-832-5216
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ06-946175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath