Provider Demographics
NPI:1619933892
Name:YODER, BONNIE (FNP)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:YODER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:
Other - Last Name:HOFSTETTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:500 S DUPONT HWY
Mailing Address - Street 2:SUITE
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-1758
Mailing Address - Country:US
Mailing Address - Phone:302-422-6050
Mailing Address - Fax:
Practice Address - Street 1:24459 SUSSEX HWY
Practice Address - Street 2:SUITE
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-4433
Practice Address - Country:US
Practice Address - Phone:302-629-3099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG0000145363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000823642Medicaid
DE0000823642Medicaid
DE870207Medicare ID - Type Unspecified