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General NPI Number Information
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NPI Number | 1437475753
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Entity Type | Individual
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Provider Name | MICHAEL P BONGIORNO NP
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Gender | Male
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Dates
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Enumeration Date | 04/12/2010
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Last Update Date | 10/23/2025
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Provider Practice Location Address
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Address Line | 1741 SYCAMORE AVE
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City | KINGMAN
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State | AZ
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Zip | 86409-0927
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Country | US
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Telephone | 928-757-8111
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Fax |
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Provider Business Mailing Address
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Address Line | 3798 E LASS AVE
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City | KINGMAN
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State | AZ
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Zip | 86409-0817
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Country | US
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Telephone | 440-487-6475
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 0027525
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 71016143A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | PN.135636-M-IV
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP246670
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License Number State | AZ
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