Healthcare Provider Details

I. General information

NPI: 1700937745
Provider Name (Legal Business Name): BONNIE COONS RN MSN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 COULTER RD
CLIFTON SPRINGS NY
14432-1122
US

IV. Provider business mailing address

2 COULTER ROAD
CLIFTON SPRINGS NY
14432
US

V. Phone/Fax

Practice location:
  • Phone: 315-462-6500
  • Fax: 315-462-6731
Mailing address:
  • Phone: 315-462-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF3321140
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: