Provider Demographics
NPI:1407644206
Name:BONHAM, EMILY (RDN)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:BONHAM
Suffix:
Gender:
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 LEFTHAND CREEK LN APT J307
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6981
Mailing Address - Country:US
Mailing Address - Phone:304-644-3163
Mailing Address - Fax:304-644-3163
Practice Address - Street 1:2121 E HARMONY RD BLDG 1A
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-3400
Practice Address - Country:US
Practice Address - Phone:970-297-6765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered