Provider Demographics
NPI:1457497745
Name:NEITZKE, BONNIE HAHN (NP)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:HAHN
Last Name:NEITZKE
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 1:2402 HERRON ROAD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:MI
Mailing Address - Zip Code:49635
Mailing Address - Country:US
Mailing Address - Phone:231-920-0986
Mailing Address - Fax:
Practice Address - Street 1:2402 HERRON RD
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:MI
Practice Address - Zip Code:49635-9157
Practice Address - Country:US
Practice Address - Phone:231-920-0986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704079367363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily