Provider Demographics
NPI:1083605950
Name:BEARDSLEE, BONITA C (CNS)
Entity Type:Individual
Prefix:
First Name:BONITA
Middle Name:C
Last Name:BEARDSLEE
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5025 ARLINGTON CENTRE BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2959
Mailing Address - Country:US
Mailing Address - Phone:614-538-8300
Mailing Address - Fax:614-538-1656
Practice Address - Street 1:5025 ARLINGTON CENTRE BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2959
Practice Address - Country:US
Practice Address - Phone:614-538-8300
Practice Address - Fax:614-538-1656
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA06472NS364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHBENS02021Medicare PIN
OHP36482Medicare UPIN