Provider Demographics
NPI:1629082623
Name:STOJADINOVIC, BONNIE J (APNP)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:J
Last Name:STOJADINOVIC
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:MRS
Other - First Name:BONNIE
Other - Middle Name:J
Other - Last Name:SIEBELINK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-2851
Mailing Address - Fax:414-266-4966
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-266-2851
Practice Address - Fax:414-266-4966
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1604363L00000X
WI102742363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43959800Medicaid
WI1629082623Medicaid
WI0088 73-601Medicare ID - Type UnspecifiedMILWAUKEE COUNTY
WI43959800Medicaid