Provider Demographics
NPI:1588651004
Name:BONNEY, CINDY (CNM)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:BONNEY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3260 PROVIDENCE DR STE 322
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4608
Mailing Address - Country:US
Mailing Address - Phone:907-563-5151
Mailing Address - Fax:907-563-6278
Practice Address - Street 1:4115 LAKE OTIS PKWY
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5213
Practice Address - Country:US
Practice Address - Phone:907-563-7228
Practice Address - Fax:907-563-6278
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0170032367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP1525Medicaid
AKNP15251Medicaid
AKNM0349Medicaid
AKNP15251Medicaid
AKNM0349Medicaid
AK161504Medicare PIN