Provider Demographics
NPI:1356508998
Name:REBELLA, BONNIE S (NP)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:S
Last Name:REBELLA
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 1:6010 S MASON MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-3706
Mailing Address - Country:US
Mailing Address - Phone:513-246-7008
Mailing Address - Fax:513-204-6393
Practice Address - Street 1:6010 S MASON MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-3706
Practice Address - Country:US
Practice Address - Phone:513-246-7008
Practice Address - Fax:513-204-6393
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-09756363L00000X
OHAPRN.CNP.09756363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner