Provider Demographics
NPI:1477695708
Name:BONNETT, DENISE (APRN,BC)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:
Last Name:BONNETT
Suffix:
Gender:F
Credentials:APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:ROSENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:54974-9759
Mailing Address - Country:US
Mailing Address - Phone:920-872-5053
Mailing Address - Fax:
Practice Address - Street 1:1 W LINCOLN ST
Practice Address - Street 2:BOX 661
Practice Address - City:WAUPUN
Practice Address - State:WI
Practice Address - Zip Code:53963-1949
Practice Address - Country:US
Practice Address - Phone:920-324-6235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI80108-30363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily