Provider Demographics
NPI:1225462641
Name:BONEZZI, BROOKANA KOREEN (CPNP-PC, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:BROOKANA
Middle Name:KOREEN
Last Name:BONEZZI
Suffix:
Gender:F
Credentials:CPNP-PC, PMHNP-BC
Other - Prefix:
Other - First Name:BROOKANA
Other - Middle Name:KOREEN
Other - Last Name:KIRCHNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:446 MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-2348
Mailing Address - Country:US
Mailing Address - Phone:513-834-7063
Mailing Address - Fax:513-873-1567
Practice Address - Street 1:4075 OLD WESTERN ROW RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-3104
Practice Address - Country:US
Practice Address - Phone:513-536-4673
Practice Address - Fax:513-536-0619
Is Sole Proprietor?:No
Enumeration Date:2013-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCNP.15039363LP0808X
OHCOA.15039-NP363LP0200X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health