Provider Demographics
NPI:1790886737
Name:BONNELL, SUSAN MARIE (PNP-PC)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MARIE
Last Name:BONNELL
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Gender:F
Credentials:PNP-PC
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Mailing Address - Street 1:6910 MONTE VERDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119
Mailing Address - Country:US
Mailing Address - Phone:619-698-6454
Mailing Address - Fax:619-698-6388
Practice Address - Street 1:4305 UNIVERSITY AVENUE
Practice Address - Street 2:SUITE 150
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105
Practice Address - Country:US
Practice Address - Phone:619-563-0507
Practice Address - Fax:619-563-0015
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2015-10-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CANP13301363LP0200X
CA13301363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics