Sally Diane Bonham, BSN, MSN, FNP, IBCLC - Registered Nurse in Fort Worth, TX

Sally Diane Bonham, BSN, MSN, FNP, IBCLC is a Registered Nurse - Lactation Consultant based in Fort Worth, Texas. Sally Diane Bonham is licensed to practice in Texas (license number 638280) and her current practice location is 1400 8th Ave, Fort Worth, Texas. She can be reached at her office (for appointments etc.) via phone at (817) 648-1765.

NPI number for Sally Diane Bonham is 1811750078 and her current mailing address is 169 Private Road 1400 S, Morgan, Texas. She does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1811750078.

Contact Information

Sally Diane Bonham, BSN, MSN, FNP, IBCLC
1400 8th Ave,
Fort Worth, TX 76104-4110
(817) 648-1765
Not Available

Map and Direction




Provider's Profile

Full NameSally Diane Bonham
GenderFemale
SpecialityRegistered Nurse - Lactation Consultant
Location1400 8th Ave, Fort Worth, Texas
Accepts Medicare AssignmentsDoes not participate in Medicare Program. She may not accept medicare assignment.
  NPI Data:
  • NPI Number: 1811750078
  • Provider Enumeration Date: 01/31/2024
  • Last Update Date: 01/31/2024

Medical Identifiers

Medical identifiers for Sally Diane Bonham such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1811750078NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
163WL0100XRegistered Nurse - Lactation Consultant 638280 (Texas)Primary

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Sally Diane Bonham is NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Sally Diane Bonham, BSN, MSN, FNP, IBCLC
169 Private Road 1400 S,
Morgan, TX 76671-3283

Ph: (817) 648-1765
Sally Diane Bonham, BSN, MSN, FNP, IBCLC
1400 8th Ave,
Fort Worth, TX 76104-4110

Ph: (817) 648-1765

Reviews and Comments


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