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General NPI Number Information
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NPI Number | 1518500768
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Entity Type | Individual
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Provider Name | R WILLIAM BOHONNON APRN
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Gender | Male
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Dates
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Enumeration Date | 10/21/2019
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Last Update Date | 11/12/2025
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Provider Practice Location Address
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Address Line | 330 MAIN ST STE 101
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City | HARTFORD
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State | CT
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Zip | 06106-1860
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Country | US
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Telephone | 860-969-1101
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Fax |
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Provider Business Mailing Address
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Address Line | 1 COCHECO AVE
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City | BRANFORD
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State | CT
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Zip | 06405-5209
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Country | US
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Telephone | 203-641-9049
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 10335
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 10335
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 10335
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 10335
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License Number State | CT
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