Provider Demographics
NPI:1912030453
Name:BONNEL, GALADRIEL ANN (RN, MSN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:GALADRIEL
Middle Name:ANN
Last Name:BONNEL
Suffix:
Gender:F
Credentials:RN, MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2344 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94710-2412
Mailing Address - Country:US
Mailing Address - Phone:510-981-4100
Mailing Address - Fax:510-981-3263
Practice Address - Street 1:243 GEORGIA ST
Practice Address - Street 2:SUITE B
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-5905
Practice Address - Country:US
Practice Address - Phone:707-556-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA598883163W00000X
CA14498363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse