Healthcare Provider Details

I. General information

NPI: 1003137290
Provider Name (Legal Business Name): BONNIE L POPPY APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BONNIE LYNN GARTHWAITE

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 SHERMAN AVE E
FORT ATKINSON WI
53538-1960
US

IV. Provider business mailing address

PO BOX 249
FORT ATKINSON WI
53538-0249
US

V. Phone/Fax

Practice location:
  • Phone: 920-563-5571
  • Fax: 920-563-7705
Mailing address:
  • Phone: 920-563-4466
  • Fax: 920-568-4004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11996
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: