| Doctor Name: | AMY BONFIGLIO |
| NPI Number: | 1083085013 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APN |
| License Number: | 209013435 |
| Business Practice Address: | 200 S Greenleaf St Suite L Gurnee, IL - 600313398 |
| Business Phone Number: | 8473607888 |
| Business Fax Number: | 8473608366 |
| Mailing Address: | 200 S Greenleaf St, Suite L GURNEE |
| State: | IL |
| Postal Code: | 600313398 |
| Phone Number: | 8473607888 |
| Fax Number: | 8473608366 |
| NPI Enumeration Date: | 10/16/2015 |
| NPI Last Update Date: | 10/16/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 209013435 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |