Individual
DR. BONNIE J. WITRAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
19020 33RD AVE W STE 210, LYNNWOOD, WA 98036-4748
(425) 563-1500
(425) 563-1501
Mailing address
19020 33RD AVE W STE 210, LYNNWOOD, WA 98036-4748
(425) 563-1500
(425) 563-1374
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
M-12423
ID
2085N0700X
Neuroradiology Physician
Primary
MD00022896
WA
2085R0202X
Diagnostic Radiology Physician
M-12423
ID
2085R0202X
Diagnostic Radiology Physician
MD00022896
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
117424
L&I PROVIDER NUMBER
WA
01
—
120220
L&I PROVIDER NUMBER
WA
05
—
1720066293
—
ID
01
—
204125
L&I PROVIDER NUMBER
WA
01
—
224089
L&I PROVIDER NUMBER
WA
05
—
8131740
—
WA
Enumeration date
01/05/2006
Last updated
08/05/2019
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