Clark, Bonnie
Clark, Bonnie is an individual health care provider with primary practice located at 5400 Gibson Blvd Se , Albuquerque NM 87108-4729. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as her primary health care specialty. Clark, Bonnie can be contacted via phone (505) 262-7026.Contact Information
Primary practice address
5400 Gibson Blvd Se
Albuquerque NM 87108-4729
Phone: (505) 262-7026
Fax: (505) 727-9276
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | 79-PA004 | New Mexico |
Profile Details
| NPI number | 1508899170 |
|---|---|
| LBN Legal business name | Clark, Bonnie |
| Credentials | PA C |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 8th, 2006 |
| Last updated | Dec 18th, 2008 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1508899170 | NPPES |
| New Mexico | MEDICAID | 59428 |
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