Provider Demographics
NPI:1194188268
Name:KITCHEN, BONNIE (CNP)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:KITCHEN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36000 EUCLID AVE # MSO
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-4625
Mailing Address - Country:US
Mailing Address - Phone:440-953-6082
Mailing Address - Fax:440-953-6101
Practice Address - Street 1:9485 MENTOR AVE STE 210
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-8723
Practice Address - Country:US
Practice Address - Phone:440-255-5571
Practice Address - Fax:440-205-5744
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.18995-NP363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology