Provider Demographics
NPI:1598131328
Name:ALLEN, BONNIE M (NP-C)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:M
Last Name:ALLEN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 REID PKWY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-935-8581
Mailing Address - Fax:765-935-1171
Practice Address - Street 1:1471 CHESTER BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1945
Practice Address - Country:US
Practice Address - Phone:765-935-8581
Practice Address - Fax:765-935-1171
Is Sole Proprietor?:No
Enumeration Date:2015-08-16
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71005645A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201313040Medicaid
000000957439OtherANTHEM (REID PHYSICIAN ASSOCIATES, INC.)
OH0152309Medicaid
IN259370084Medicare PIN