Provider Demographics
NPI:1275201949
Name:CARMAN, BONITA (FNP-C)
Entity Type:Individual
Prefix:
First Name:BONITA
Middle Name:
Last Name:CARMAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43823 IRIS TRL
Mailing Address - Street 2:
Mailing Address - City:NOVINGER
Mailing Address - State:MO
Mailing Address - Zip Code:63559-2032
Mailing Address - Country:US
Mailing Address - Phone:660-988-3815
Mailing Address - Fax:
Practice Address - Street 1:43823 IRIS TRL
Practice Address - Street 2:
Practice Address - City:NOVINGER
Practice Address - State:MO
Practice Address - Zip Code:63559-2032
Practice Address - Country:US
Practice Address - Phone:660-988-3815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021027068363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily