Provider Demographics
NPI:1821505868
Name:BONHAM, JEANNE (APRN)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:BONHAM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 HWY 10
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NE
Mailing Address - Zip Code:68939-5170
Mailing Address - Country:US
Mailing Address - Phone:402-213-7855
Mailing Address - Fax:
Practice Address - Street 1:3900 PINE LAKE RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-5489
Practice Address - Country:US
Practice Address - Phone:402-213-7855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-29
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111668363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology