Provider Demographics
NPI:1396005559
Name:BRAHANEY, BONNIE J (CNP)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:J
Last Name:BRAHANEY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1 SEAGATE STE 800
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1558
Mailing Address - Country:US
Mailing Address - Phone:419-824-6599
Mailing Address - Fax:419-882-3870
Practice Address - Street 1:5308 HARROUN RD
Practice Address - Street 2:SUITE 055
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2114
Practice Address - Country:US
Practice Address - Phone:419-824-6599
Practice Address - Fax:419-885-3870
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.199232363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0068423Medicaid
OHH112160Medicare PIN