1083468359 NPI number — BONNIE LYNN AYOTTE LH 60996772

Table of content: BONNIE LYNN AYOTTE LH 60996772 (NPI 1083468359)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083468359 NPI number — BONNIE LYNN AYOTTE LH 60996772

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AYOTTE
Provider First Name:
BONNIE
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LH 60996772
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ST GEORGE
Provider Other First Name:
BONNIE
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1083468359
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5504 SKYVUE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLAINE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98230-9538
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-480-5634
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5504 SKYVUE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLAINE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98230-9538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-480-5634
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/15/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  60996772 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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