Healthcare Provider Details

I. General information

NPI: 1982539847
Provider Name (Legal Business Name): ANDREW BONNELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12117 VILLAGE WOODS DR
CINCINNATI OH
45241-6068
US

IV. Provider business mailing address

12117 VILLAGE WOODS DR
CINCINNATI OH
45241-6068
US

V. Phone/Fax

Practice location:
  • Phone: 513-377-0565
  • Fax:
Mailing address:
  • Phone: 513-377-0565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number158799
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.505085
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: