Healthcare Provider Details

I. General information

NPI: 1356508998
Provider Name (Legal Business Name): BONNIE S REBELLA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6010 S MASON MONTGOMERY RD
MASON OH
45040-3706
US

IV. Provider business mailing address

6010 S MASON MONTGOMERY RD
MASON OH
45040-3706
US

V. Phone/Fax

Practice location:
  • Phone: 513-246-7008
  • Fax: 513-204-6393
Mailing address:
  • Phone: 513-246-7008
  • Fax: 513-204-6393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP-09756
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN.CNP.09756
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: