Provider Demographics
NPI:1073645966
Name:BONACCI, JENNY JOAN (RN, CNS, CPNP)
Entity Type:Individual
Prefix:MS
First Name:JENNY
Middle Name:JOAN
Last Name:BONACCI
Suffix:
Gender:F
Credentials:RN, CNS, CPNP
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:JOAN
Other - Last Name:SANFORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8445 GREENTRAILS WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-4501
Mailing Address - Country:US
Mailing Address - Phone:916-688-1414
Mailing Address - Fax:
Practice Address - Street 1:1600 EUREKA RD
Practice Address - Street 2:BUILDING C, UROLOGY
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3027
Practice Address - Country:US
Practice Address - Phone:916-784-4160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA587187163W00000X, 364SP0200X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
No364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics