Provider Demographics
NPI:1962977140
Name:BEKALO-QUINLAN, KRYSTLE SHARNA BONCATO (RN, FNP-C)
Entity type:Individual
Prefix:
First Name:KRYSTLE SHARNA
Middle Name:BONCATO
Last Name:BEKALO-QUINLAN
Suffix:
Gender:F
Credentials:RN, FNP-C
Other - Prefix:
Other - First Name:KRYSTLE SHARNA
Other - Middle Name:BONCATO
Other - Last Name:BEKALO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24920 MOUND ST
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92350-0202
Mailing Address - Country:US
Mailing Address - Phone:479-420-1746
Mailing Address - Fax:
Practice Address - Street 1:24920 MOUND ST
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92350
Practice Address - Country:US
Practice Address - Phone:479-420-1746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009956363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty