Healthcare Provider Details

I. General information

NPI: 1033527080
Provider Name (Legal Business Name): JANICE BONNETT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2014
Last Update Date: 07/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 E UNIVERSITY DR SUITE 6
MESA AZ
85203-8237
US

IV. Provider business mailing address

1840 E UNIVERSITY DR SUITE 6
MESA AZ
85203-8237
US

V. Phone/Fax

Practice location:
  • Phone: 480-246-3560
  • Fax:
Mailing address:
  • Phone: 480-246-3560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberAP0278
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: