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NPI Code Detail

MEDICARE: NINFA BONTES NP

MEDICARE: NINFA BONTES NP
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
1363LF0000XFamily Nurse Practitioner209011567IL

General Provider Information

NPI Number : 1528475571
Entity Type Code : Individual
Provider Name (Legal Business Name) : NINFA BONTES NP
Provider Business Mailing Address
First Line : 4711 GOLF RD
Second Line : 1250
City : SKOKIE
State : IL
Zip : 60076-1224
Country : US
Telephone Number : 847-235-6130
Fax Number :
Provider Business Practice Location Address
First Line : 2534 ELIM AVE
Second Line :
City : ZION
State : IL
Zip : 60099-2661
Country : US
Telephone Number : 847-746-8435
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2014
Last Update Date : 07/22/2014

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