Healthcare Provider Details

I. General information

NPI: 1427454115
Provider Name (Legal Business Name): ANGELA BONNER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2014
Last Update Date: 11/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1423 AVEN DR
COLUMBUS OH
43227-3263
US

IV. Provider business mailing address

1423 AVEN DR
COLUMBUS OH
43227-3263
US

V. Phone/Fax

Practice location:
  • Phone: 614-795-9883
  • Fax:
Mailing address:
  • Phone: 614-795-9883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberRN395172
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: