Healthcare Provider Details

I. General information

NPI: 1316752876
Provider Name (Legal Business Name): STEPHANIE LYNNE BONZEK APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

649 HARKLE RD
SANTA FE NM
87505-4765
US

IV. Provider business mailing address

PO BOX 6880
SANTA FE NM
87502-6880
US

V. Phone/Fax

Practice location:
  • Phone: 505-955-9454
  • Fax:
Mailing address:
  • Phone: 505-216-0332
  • Fax: 505-982-0279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number82764
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: