Provider Demographics
NPI:1407815475
Name:ST. JOHN, BONNIE L (NP)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:L
Last Name:ST. JOHN
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 1:615 FAIRHURST ST
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-4523
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:615 FAIRHURST ST
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-4564
Practice Address - Country:US
Practice Address - Phone:970-526-8100
Practice Address - Fax:970-521-3183
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO63477367A00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO7634777Medicaid
R18694Medicare UPIN
CO7634777Medicaid
COCOA100113Medicare PIN