Healthcare Provider Details

I. General information

NPI: 1548694771
Provider Name (Legal Business Name): KENDRA M BONNESEN ARNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2013
Last Update Date: 07/17/2020
Certification Date: 07/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 S WHITE ST STE 103
MOUNT PLEASANT IA
52641-2263
US

IV. Provider business mailing address

407 S WHITE ST STE 103
MOUNT PLEASANT IA
52641-2263
US

V. Phone/Fax

Practice location:
  • Phone: 319-385-6770
  • Fax: 319-385-5409
Mailing address:
  • Phone: 319-385-6770
  • Fax: 319-385-5409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA119626
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberCNM2374
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: