Provider Demographics
NPI:1558327148
Name:ADLER, BONNIE EDITH (CNM, NP)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:EDITH
Last Name:ADLER
Suffix:
Gender:F
Credentials:CNM, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 BRINKERHOFF ST
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2919
Mailing Address - Country:US
Mailing Address - Phone:518-561-4430
Mailing Address - Fax:518-561-2387
Practice Address - Street 1:66 BRINKERHOFF ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2919
Practice Address - Country:US
Practice Address - Phone:518-561-4430
Practice Address - Fax:518-561-2387
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000013-1176B00000X
NY420354363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01355893Medicaid