Provider Demographics
NPI:1932252509
Name:SANDAHL, BONNIE BEARDSLEY (M N, A R N P)
Entity type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:BEARDSLEY
Last Name:SANDAHL
Suffix:
Gender:F
Credentials:M N, A R N P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 201ST PL SW
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-7060
Mailing Address - Country:US
Mailing Address - Phone:425-776-2341
Mailing Address - Fax:
Practice Address - Street 1:9430 30TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-3963
Practice Address - Country:US
Practice Address - Phone:206-252-9570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30000053363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9610296Medicaid