Basic Information
Provider Information
NPI: 1003292137
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STRICKLAND
FirstName: BONNIE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 711 N TAYLOR ST
Address2:  
City: GUNNISON
State: CO
PostalCode: 812302296
CountryCode: US
TelephoneNumber: 9706428413
FaxNumber: 9706419017
Practice Location
Address1: 707 N IOWA ST
Address2:  
City: GUNNISON
State: CO
PostalCode: 812302229
CountryCode: US
TelephoneNumber: 9706428413
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/30/2015
LastUpdateDate: 01/24/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/24/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XAPN.0991874-NPCOY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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