Healthcare Provider Details

I. General information

NPI: 1457497745
Provider Name (Legal Business Name): BONNIE HAHN NEITZKE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2402 HERRON RD
FRANKFORT MI
49635-9157
US

IV. Provider business mailing address

2402 HERRON ROAD
FRANKFORT MI
49635
US

V. Phone/Fax

Practice location:
  • Phone: 231-920-0986
  • Fax:
Mailing address:
  • Phone: 231-920-0986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704079367
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: