Provider Demographics
NPI:1134127145
Name:BRENEMAN, BONNIE L (RNC/WHNP)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:L
Last Name:BRENEMAN
Suffix:
Gender:F
Credentials:RNC/WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7689 SHEFFIELD VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-1718
Mailing Address - Country:US
Mailing Address - Phone:703-550-6023
Mailing Address - Fax:703-805-0311
Practice Address - Street 1:9501 FARRELL RD
Practice Address - Street 2:
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-5901
Practice Address - Country:US
Practice Address - Phone:703-805-0311
Practice Address - Fax:703-805-9351
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024050799363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health