Healthcare Provider Details

I. General information

NPI: 1770735987
Provider Name (Legal Business Name): JESSICA LYNETTE BONNER RN,BSN,CNOR,RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S DOBSON RD
MESA AZ
85202-4707
US

IV. Provider business mailing address

1900 W CHANDLER BLVD STE 15-143
CHANDLER AZ
85224-8632
US

V. Phone/Fax

Practice location:
  • Phone: 480-512-3500
  • Fax:
Mailing address:
  • Phone: 480-861-0432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN095926
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: