Provider Demographics
NPI:1255331112
Name:WEBSTER, BONNIE JEAN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:JEAN
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10995 ALLISONVILLE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-2616
Mailing Address - Country:US
Mailing Address - Phone:317-842-7928
Mailing Address - Fax:
Practice Address - Street 1:10995 ALLISONVILLE RD STE 100
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-2616
Practice Address - Country:US
Practice Address - Phone:317-842-7928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001224A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN219090BMedicare ID - Type UnspecifiedMEDICARE#
INP52863Medicare UPIN