Provider Demographics
NPI:1710312111
Name:BONNER, ALEXIS (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:BONNER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15515 71ST AVE
Mailing Address - Street 2:2A
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2216
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15515 71ST AVE
Practice Address - Street 2:2A
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-2216
Practice Address - Country:US
Practice Address - Phone:347-439-1642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF346414363LX0001X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology