Doctor Name: | JAIME BONNER |
NPI Number: | 1649669698 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | ARNP |
License Number: | A112779 |
Business Practice Address: | 720 Pacha Pkwy Suite 1 North Liberty, IA - 523174797 |
Business Phone Number: | 3193848822 |
Business Fax Number: | |
Mailing Address: | 720 Pacha Pkwy, Suite 1 NORTH LIBERTY |
State: | IA |
Postal Code: | 523174797 |
Phone Number: | 3193848822 |
Fax Number: | |
NPI Enumeration Date: | 01/14/2015 |
NPI Last Update Date: | 12/31/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | A112779 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |