Provider Demographics
NPI:1619953312
Name:RADEMACHER-FLIS, BONNIE L (CNP)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:L
Last Name:RADEMACHER-FLIS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ST. ANDREWS LANE
Mailing Address - Street 2:LINCOLN HEALTH WOUND CARE CENTER
Mailing Address - City:BOOTHBAY HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04578-1847
Mailing Address - Country:US
Mailing Address - Phone:207-633-1600
Mailing Address - Fax:207-633-1615
Practice Address - Street 1:6 ST. ANDREWS LANE
Practice Address - Street 2:
Practice Address - City:BOOTHBAY HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04538-1847
Practice Address - Country:US
Practice Address - Phone:207-633-1600
Practice Address - Fax:207-633-1615
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001556364S00000X
MECNP121078363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004246907Medicaid
ME1619953312Medicaid
ME003002101Medicare PIN
CT004246907Medicaid