Doctor Name: | BONNIE JEAN BARTLETT |
NPI Number: | 1043367295 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APN |
License Number: | |
Business Practice Address: | 1 University Cir Macomb, IL - 614551367 |
Business Phone Number: | 3092981888 |
Business Fax Number: | |
Mailing Address: | 21495 State Route 41, PRAIRIE CITY |
State: | IL |
Postal Code: | 614708319 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 01/03/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0200X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Pediatrics |
Taxonomy Definition: |