Provider Demographics
NPI:1962805267
Name:CHAN, BONNIE (RPYT, CNA, LMP)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:RPYT, CNA, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 N 74TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-5010
Mailing Address - Country:US
Mailing Address - Phone:206-383-0686
Mailing Address - Fax:
Practice Address - Street 1:149 N 74TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-5010
Practice Address - Country:US
Practice Address - Phone:206-383-0686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133NN1002X, 174H00000X, 374J00000X
WAMA60269416225700000X
WANC60499700376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No174H00000XOther Service ProvidersHealth Educator
No374J00000XNursing Service Related ProvidersDoula
No376K00000XNursing Service Related ProvidersNurse's Aide