Basic Information
| Provider Information | |||||||||
| NPI: | 1275525008 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURNQUIST | ||||||||
| FirstName: | BONNIE | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 71 OMEGA DR | ||||||||
| Address2: | BUILDING D | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197132063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3022833300 | ||||||||
| FaxNumber: | 3022833321 | ||||||||
| Practice Location | |||||||||
| Address1: | 118 ATLANTIC AVE | ||||||||
| Address2: | SUITE201 | ||||||||
| City: | OCEAN VIEW | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199709163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3025376110 | ||||||||
| FaxNumber: | 3025374666 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2005 | ||||||||
| LastUpdateDate: | 11/05/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | C10007200 | DE | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00236460 | 01 | DE | RAILROAD | OTHER |