Provider Demographics
NPI:1609194737
Name:GANCE-CLEVELAND, BONNIE (PNP)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:GANCE-CLEVELAND
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N 3RD ST
Mailing Address - Street 2:MAILCODE 3020
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-2135
Mailing Address - Country:US
Mailing Address - Phone:602-496-0908
Mailing Address - Fax:602-496-0986
Practice Address - Street 1:500 NORTH 3RD ST
Practice Address - Street 2:SUITE 155
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-0698
Practice Address - Country:US
Practice Address - Phone:602-496-0721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN139505163W00000X
AZAP3039363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse