Provider Demographics
NPI:1225018179
Name:EMPEL, BONITA K (CRNA)
Entity Type:Individual
Prefix:
First Name:BONITA
Middle Name:K
Last Name:EMPEL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:BONITA
Other - Middle Name:K
Other - Last Name:MATELIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:DEPARTMENT 4676
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60122-4676
Mailing Address - Country:US
Mailing Address - Phone:952-442-9770
Mailing Address - Fax:
Practice Address - Street 1:28500 ORCHARD LAKE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2936
Practice Address - Country:US
Practice Address - Phone:952-442-9770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704084743367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104411363Medicaid
MIBM084743OtherBLUE CROSS OF MI
MIN24360190Medicare ID - Type Unspecified
MI430076853Medicare ID - Type UnspecifiedRAILROAD MEDICARE