Healthcare Provider Details

I. General information

NPI: 1053750554
Provider Name (Legal Business Name): HILLARY MARIE BONIN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2013
Last Update Date: 06/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 S 70TH ST STE 305
LINCOLN NE
68510-2471
US

IV. Provider business mailing address

7130 S 91ST ST APT 516
LINCOLN NE
68526-9669
US

V. Phone/Fax

Practice location:
  • Phone: 402-434-5600
  • Fax: 402-434-5601
Mailing address:
  • Phone: 816-799-8091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number101230
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: