Basic Information
| Provider Information | |||||||||
| NPI: | 1053726794 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LENYARD | ||||||||
| FirstName: | BONNIE | ||||||||
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| Credential: | PMHNP-BC, FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2106 W KATHLEEN RD | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850237255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6027582158 | ||||||||
| FaxNumber: | 6027725771 | ||||||||
| Practice Location | |||||||||
| Address1: | 16155 N 83RD AVE STE 211 | ||||||||
| Address2: | |||||||||
| City: | PEORIA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853825815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6023995792 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2014 | ||||||||
| LastUpdateDate: | 09/01/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | TAP5663 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.