Healthcare Provider Details

I. General information

NPI: 1225462641
Provider Name (Legal Business Name): BROOKANA KOREEN BONEZZI CPNP-PC, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BROOKANA KOREEN KIRCHNER

II. Dates (important events)

Enumeration Date: 08/22/2013
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3777 SELMA LN
BRUNSWICK OH
44212-4428
US

IV. Provider business mailing address

3777 SELMA LN
BRUNSWICK OH
44212-4428
US

V. Phone/Fax

Practice location:
  • Phone: 347-222-8843
  • Fax:
Mailing address:
  • Phone: 347-222-8843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberCOA.15039-NP
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP.15039
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: