Provider Demographics
NPI:1346884459
Name:BOHNE, LAURIE ANN (APRN)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANN
Last Name:BOHNE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 SPRING LAKE RD
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62305-7763
Mailing Address - Country:US
Mailing Address - Phone:217-779-8629
Mailing Address - Fax:
Practice Address - Street 1:1229 SPRING LAKE RD
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62305-7763
Practice Address - Country:US
Practice Address - Phone:217-779-8629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.020345363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily