Provider Demographics
NPI:1861831786
Name:BOHNSACK, PANDORA LYN
Entity Type:Individual
Prefix:
First Name:PANDORA
Middle Name:LYN
Last Name:BOHNSACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4330 NAVARRE AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3578
Mailing Address - Country:US
Mailing Address - Phone:419-691-7820
Mailing Address - Fax:419-691-7593
Practice Address - Street 1:4330 NAVARRE AVE
Practice Address - Street 2:STE 103
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3578
Practice Address - Country:US
Practice Address - Phone:419-691-7820
Practice Address - Fax:419-691-7593
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OHAPRN.CNP.14712363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program