| Doctor Name: | JAMIE R BOHNKE |
| NPI Number: | 1023457637 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CPNP |
| License Number: | 71004476A |
| Business Practice Address: | 1614 25th St Bedford, IN - 474215000 |
| Business Phone Number: | 8122770118 |
| Business Fax Number: | 8122770127 |
| Mailing Address: | Po Box 1329, BLOOMINGTON |
| State: | IN |
| Postal Code: | 474021329 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 06/17/2013 |
| NPI Last Update Date: | 03/02/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | 71004476A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |