Healthcare Provider Details

I. General information

NPI: 1326338773
Provider Name (Legal Business Name): ASHLIE ANN BONDARENKO RN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLIE ANN GRUBE

II. Dates (important events)

Enumeration Date: 04/19/2011
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14551 COUNTY ROAD 11 STE 100
BURNSVILLE MN
55337-4799
US

IV. Provider business mailing address

7235 OHMS LN
EDINA MN
55439-2148
US

V. Phone/Fax

Practice location:
  • Phone: 952-841-2345
  • Fax: 952-841-2346
Mailing address:
  • Phone: 952-841-2345
  • Fax: 952-841-2346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR 197213-7
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5291
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5291
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: