Healthcare Provider Details

I. General information

NPI: 1992695498
Provider Name (Legal Business Name): ASHLEY MARIE BONNOT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 W BLOOMFIELD RD STE C
BLOOMINGTON IN
47403-2001
US

IV. Provider business mailing address

612 E HARRISON CT
ELLETTSVILLE IN
47429-2057
US

V. Phone/Fax

Practice location:
  • Phone: 812-334-2772
  • Fax:
Mailing address:
  • Phone: 330-704-4876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71016802A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: