Provider Demographics
NPI:1518402064
Name:BONE, BLAIR ELIZABETH (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:BLAIR
Middle Name:ELIZABETH
Last Name:BONE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 306
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:IL
Mailing Address - Zip Code:62236-0306
Mailing Address - Country:US
Mailing Address - Phone:618-567-9821
Mailing Address - Fax:618-939-9836
Practice Address - Street 1:13745 MARY LN
Practice Address - Street 2:
Practice Address - City:AVISTON
Practice Address - State:IL
Practice Address - Zip Code:62216-4732
Practice Address - Country:US
Practice Address - Phone:618-567-9821
Practice Address - Fax:618-939-9836
Is Sole Proprietor?:No
Enumeration Date:2016-12-19
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209105303363LF0000X
IL209.015303363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily