Healthcare Provider Details

I. General information

NPI: 1396026266
Provider Name (Legal Business Name): NIKKI A. BONITZ CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2116 CRAIG RD
EAU CLAIRE WI
54701-6118
US

IV. Provider business mailing address

507 S MONROE ST
LANCASTER WI
53813-2099
US

V. Phone/Fax

Practice location:
  • Phone: 715-858-4500
  • Fax:
Mailing address:
  • Phone: 608-723-2143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number7476
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberD156873
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: