Healthcare Provider Details

I. General information

NPI: 1063858090
Provider Name (Legal Business Name): SUZANNE ELAINE BOHNKER ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2013
Last Update Date: 05/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 EXECUTIVE PARKWAY DR SUITE 210
SAINT LOUIS MO
63141-6336
US

IV. Provider business mailing address

747 3RD AVE SUITE 28A
NEW YORK NY
10017-2803
US

V. Phone/Fax

Practice location:
  • Phone: 314-514-6000
  • Fax: 866-497-1239
Mailing address:
  • Phone: 314-514-6000
  • Fax: 866-497-1239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberF306-155-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: