MEDICARE: BONNIE TOY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner		IL

General Provider Information

NPI Number	:	1174794689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONNIE TOY

Provider Business Mailing Address
First Line	:	5841 S MARYLAND AVE
Second Line	:	MC 4060
City	:	CHICAGO
State	:	IL
Zip	:	60637-1447
Country	:	US
Telephone Number	:	773-702-6808
Fax Number	:	773-702-9881

Provider Business Practice Location Address
First Line	:	5841 S MARYLAND AVE
Second Line	:	MC 4060
City	:	CHICAGO
State	:	IL
Zip	:	60637-1447
Country	:	US
Telephone Number	:	773-702-6808
Fax Number	:	773-702-9881

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2008
Last Update Date	:	03/12/2008

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Directions to “ BONNIE TOY ” Practice Location

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