Provider Demographics
NPI:1427396381
Name:BONCU, OTILIA (APN, NP-C)
Entity Type:Individual
Prefix:
First Name:OTILIA
Middle Name:
Last Name:BONCU
Suffix:
Gender:F
Credentials:APN, NP-C
Other - Prefix:
Other - First Name:OTILIA
Other - Middle Name:
Other - Last Name:BODOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:380 N TERRA COTTA RD
Mailing Address - Street 2:STE A
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60012-1809
Mailing Address - Country:US
Mailing Address - Phone:815-444-6362
Mailing Address - Fax:
Practice Address - Street 1:380 N TERRA COTTA RD
Practice Address - Street 2:STE A
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60012-1809
Practice Address - Country:US
Practice Address - Phone:815-444-6362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-27
Last Update Date:2013-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.010170363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily