Healthcare Provider Details

I. General information

NPI: 1013930833
Provider Name (Legal Business Name): BONNIE L ENGEL APRN, CS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 N 2ND ST
BISMARCK ND
58501-3826
US

IV. Provider business mailing address

700 N 19TH ST
BISMARCK ND
58501-4720
US

V. Phone/Fax

Practice location:
  • Phone: 701-224-8783
  • Fax:
Mailing address:
  • Phone: 701-224-8783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License NumberR20929
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: