Provider Demographics
NPI:1497876056
Name:HARE, BONNIE ROSE (RN, WHNP-BC)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:ROSE
Last Name:HARE
Suffix:
Gender:F
Credentials:RN, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 E. CAMELBACK ROAD
Mailing Address - Street 2:STE 160
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016
Mailing Address - Country:US
Mailing Address - Phone:602-241-1671
Mailing Address - Fax:602-230-7982
Practice Address - Street 1:1661 E. CAMELBACK ROAD
Practice Address - Street 2:STE 160
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016
Practice Address - Country:US
Practice Address - Phone:602-241-1671
Practice Address - Fax:602-230-7982
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN067325363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health