MEDICARE: MRS. BONNIE CELLA MSN, RN, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F02170111	MO

General Provider Information

NPI Number	:	1811414758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BONNIE CELLA MSN, RN, FNP-C

Provider Business Mailing Address
First Line	:	13131 TESSON FERRY RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-3814
Country	:	US
Telephone Number	:	314-756-8035
Fax Number	:

Provider Business Practice Location Address
First Line	:	13131 TESSON FERRY RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-3814
Country	:	US
Telephone Number	:	314-756-8035
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2017
Last Update Date	:	11/15/2018

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