Provider Demographics
NPI:1720192883
Name:BARTZ, BONNIE R (NP)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:R
Last Name:BARTZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 W CHISHOLM ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-1401
Mailing Address - Country:US
Mailing Address - Phone:989-356-5228
Mailing Address - Fax:989-358-3712
Practice Address - Street 1:1501 W CHISHOLM ST
Practice Address - Street 2:SUITE 201
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-1401
Practice Address - Country:US
Practice Address - Phone:989-356-5228
Practice Address - Fax:989-358-3712
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704158381363LW0102X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIZ16001075Medicare PIN
MAP01552Medicare UPIN