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General NPI Number Information
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NPI Number | 1558605485
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Entity Type | Individual
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Provider Name | LINDSAY B BONAVENTURA NP
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Gender | Female
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 07/30/2024
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Provider Practice Location Address
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Address Line | 1033 N INDIANA AVE
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City | SYRACUSE
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State | IN
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Zip | 46567-1017
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Country | US
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Telephone | 574-457-5701
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Fax | 574-457-5609
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Provider Business Mailing Address
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Address Line | PO BOX 834
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City | GOSHEN
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State | IN
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Zip | 46527-0834
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Country | US
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Telephone | 574-364-2592
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Fax | 574-364-2759
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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 | 71004237A
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License Number State | IN
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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 | 71004237A
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License Number State | IN
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