1184920241 NPI number — BONNIE BARE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184920241 NPI number — BONNIE BARE

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SILVA
Provider Other First Name:
BONNIE
Provider Other Middle Name:
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:
1184920241
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
727 FAIRVIEW DR
Provider Second Line Business Mailing Address:
STE A
Provider Business Mailing Address City Name:
CARSON CITY
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-687-5018
Provider Business Mailing Address Fax Number:
775-687-1181

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
RURAL CLINICS BATTLE MOUNTAIN
Provider Second Line Business Practice Location Address:
825 N. 2ND STREET
Provider Business Practice Location Address City Name:
BATTLE MOUNTAIN
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89820-2834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-635-5753
Provider Business Practice Location Address Fax Number:
775-635-8028
Provider Enumeration Date:
02/07/2011

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: 225C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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