Provider Demographics
NPI:1083085013
Name:BONFIGLIO, AMY (APN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BONFIGLIO
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S GREENLEAF ST
Mailing Address - Street 2:SUITE L
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3398
Mailing Address - Country:US
Mailing Address - Phone:847-360-7888
Mailing Address - Fax:847-360-8366
Practice Address - Street 1:431 W LIBERTY ST
Practice Address - Street 2:
Practice Address - City:WAUCONDA
Practice Address - State:IL
Practice Address - Zip Code:60084-2452
Practice Address - Country:US
Practice Address - Phone:847-526-2151
Practice Address - Fax:847-526-2017
Is Sole Proprietor?:No
Enumeration Date:2015-10-16
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209013435363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily