Provider Demographics
NPI:1285626242
Name:KOSKI, BONNIE LOU (DRNP, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:LOU
Last Name:KOSKI
Suffix:
Gender:F
Credentials:DRNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:NIAGARA
Mailing Address - State:WI
Mailing Address - Zip Code:54151-1043
Mailing Address - Country:US
Mailing Address - Phone:888-724-6377
Mailing Address - Fax:715-251-1681
Practice Address - Street 1:1601 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:NIAGARA
Practice Address - State:WI
Practice Address - Zip Code:54151-1043
Practice Address - Country:US
Practice Address - Phone:888-724-6377
Practice Address - Fax:715-251-1681
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2038-033363L00000X
MI4704139032363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1285626242Medicaid
MI0B10056OtherBCBS OF MI
WI21329700Medicaid
WI21329700Medicaid
N10870Medicare UPIN
MIM24440019Medicare PIN
MIN87160014Medicare PIN