Provider Demographics
NPI:1346324860
Name:OETMAN, BONNIE K (NP)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:K
Last Name:OETMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 LAKE LANSING RD STE 201
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3757
Mailing Address - Country:US
Mailing Address - Phone:517-913-3900
Mailing Address - Fax:517-913-3901
Practice Address - Street 1:1540 LAKE LANSING RD STE 201
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3757
Practice Address - Country:US
Practice Address - Phone:517-913-3900
Practice Address - Fax:517-913-3901
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704098641363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1059825OtherMCLAREN HEALTH PLAN-COMMERCIAL
MI4376184Medicaid
MI5008766030OtherBCBS
MI0N55170001OtherMEDICARE ADVANTAGE
MI1059825OtherMCLAREN HEALTH PLAN-MEDICAID
MI1059825OtherMCLAREN HEALTH ADVANTAGE
MI9492259OtherAETNA
MI500020133OtherRAILROAD MEDICARE
MIN55170001Medicare PIN
MI4376184Medicaid