Provider Demographics
NPI:1568813301
Name:BONFANTE, IVONNE KATHERINE (RN)
Entity Type:Individual
Prefix:
First Name:IVONNE
Middle Name:KATHERINE
Last Name:BONFANTE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1595 UNIONPORT RD
Mailing Address - Street 2:APT#6G
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-5909
Mailing Address - Country:US
Mailing Address - Phone:347-757-7239
Mailing Address - Fax:
Practice Address - Street 1:1595 UNIONPORT RD
Practice Address - Street 2:APT#6G
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-5909
Practice Address - Country:US
Practice Address - Phone:347-757-7239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY634657163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse