Provider Demographics
NPI:1376184010
Name:BONJEAN, BOYANN BEA (NP)
Entity Type:Individual
Prefix:
First Name:BOYANN
Middle Name:BEA
Last Name:BONJEAN
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 1:1243 SURREY CT
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-5239
Mailing Address - Country:US
Mailing Address - Phone:219-682-6872
Mailing Address - Fax:219-769-2642
Practice Address - Street 1:8550 BROADWAY
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7173
Practice Address - Country:US
Practice Address - Phone:219-769-3550
Practice Address - Fax:219-769-2642
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28083687A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily