Provider Demographics
NPI:1679622146
Name:BONNETTE, MARY LYNN (PHD, MSN, RN)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:LYNN
Last Name:BONNETTE
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Gender:F
Credentials:PHD, MSN, RN
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Mailing Address - Street 1:1920 VIRGINIA AVE
Mailing Address - Street 2:401
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-3352
Mailing Address - Country:US
Mailing Address - Phone:239-334-2677
Mailing Address - Fax:239-334-3327
Practice Address - Street 1:2780 CLEVELAND AVE
Practice Address - Street 2:810
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-5858
Practice Address - Country:US
Practice Address - Phone:239-337-4332
Practice Address - Fax:239-334-3327
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2008-07-11
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Provider Licenses
StateLicense IDTaxonomies
FLRN 1088062364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult