Healthcare Provider Details

I. General information

NPI: 1417194903
Provider Name (Legal Business Name): BONNIE K BEHM CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2009
Last Update Date: 05/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 ROCKSIDE RD
PARMA OH
44134
US

IV. Provider business mailing address

1440 ROCKSIDE RD STE 202
PARMA OH
44134-2749
US

V. Phone/Fax

Practice location:
  • Phone: 216-749-8276
  • Fax: 216-749-8240
Mailing address:
  • Phone: 216-749-8276
  • Fax: 216-749-8240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 259661
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP.10480
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: