Provider Demographics
NPI:1467435347
Name:WILENSKY, BONNIE A (CNS)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:A
Last Name:WILENSKY
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2709
Mailing Address - Country:US
Mailing Address - Phone:303-415-4355
Mailing Address - Fax:303-666-1982
Practice Address - Street 1:1000 W SOUTH BOULDER RD STE 110
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-2753
Practice Address - Country:US
Practice Address - Phone:303-415-4355
Practice Address - Fax:303-666-1982
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0004455-CNS364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO66980364Medicaid
CO66980364Medicaid
COQ27728Medicare UPIN