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General NPI Number Information
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NPI Number | 1508140237
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Entity Type | Individual
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Provider Name | IMELDA AWUOR BONNER PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/29/2011
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 4320 BLAND RD
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City | RALEIGH
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State | NC
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Zip | 27609-6125
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Country | US
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Telephone | 919-417-4322
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Fax |
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Provider Business Mailing Address
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Address Line | 284 EXECUTIVE PARK DRIVE SUITE 100
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City | CONCORD
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State | NC
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Zip | 28025-1894
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Country | US
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Telephone | 704-939-1100
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Fax | 704-939-1173
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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 | 5019103
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License Number State | NC
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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 | 1028675
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 257911
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License Number State | AZ
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