Provider Demographics
NPI:1467702498
Name:ALBERT, BONNIE LYNNE (APRN)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:LYNNE
Last Name:ALBERT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:LYNNE
Other - Last Name:HINCKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 636324
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6324
Mailing Address - Country:US
Mailing Address - Phone:859-301-0124
Mailing Address - Fax:859-301-0699
Practice Address - Street 1:1 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017
Practice Address - Country:US
Practice Address - Phone:859-301-0124
Practice Address - Fax:859-301-0699
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006304A363LA2100X
OH13941-NP363LA2100X
KY3007687363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01824434OtherRR PTAN
OH0088853Medicaid
INP01824434OtherRR PTAN
IN266180899Medicare PIN