1831101419 NPI number — BONNY LYN WHALEN M.D.

Table of content: DEANNA NICOLE WALKER COTA/L, AC, CPRCS (NPI 1265278741)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831101419 NPI number — BONNY LYN WHALEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHALEN
Provider First Name:
BONNY
Provider Middle Name:
LYN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JOHNSTON
Provider Other First Name:
BONNY
Provider Other Middle Name:
LYN
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:
1831101419
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/05/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 MEDICAL CENTER DR.
Provider Second Line Business Mailing Address:
DHMC - DEPT OF PEDIATRICS - NEWBORN NURSERY
Provider Business Mailing Address City Name:
LEBANON
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03756-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-653-6081
Provider Business Mailing Address Fax Number:
603-650-0910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
DHMC DEPT OF PEDIATRICS - NEWBORN NURSERY
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03756-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-653-6081
Provider Business Practice Location Address Fax Number:
603-650-0910
Provider Enumeration Date:
08/12/2006

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: 208000000X , with the licence number:  12826 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3072323 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1011849 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".