| Doctor Name: | CARISSA ANN BONNER |
| NPI Number: | 1699078170 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PNP |
| License Number: | 4704250132 |
| Business Practice Address: | 9249 W Lake City Rd Houghton Lake, MI - 486299602 |
| Business Phone Number: | 9894225122 |
| Business Fax Number: | 9894224378 |
| Mailing Address: | 9249 W Lake City Rd, HOUGHTON LAKE |
| State: | MI |
| Postal Code: | 486299602 |
| Phone Number: | 9894225122 |
| Fax Number: | 9894224378 |
| NPI Enumeration Date: | 12/06/2010 |
| NPI Last Update Date: | 03/20/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | 4704250132 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |