Provider Demographics
NPI:1720079643
Name:BIRD, BONNIE MARIE (MS, FNP)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:MARIE
Last Name:BIRD
Suffix:
Gender:F
Credentials:MS, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 330
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-0026
Mailing Address - Country:US
Mailing Address - Phone:541-351-1010
Mailing Address - Fax:541-574-7670
Practice Address - Street 1:1010 SW COAST HWY STE 203
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-5215
Practice Address - Country:US
Practice Address - Phone:541-265-4947
Practice Address - Fax:541-994-0261
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200850004 NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily