Provider Demographics
NPI:1942811047
Name:ANDERSON, BONNIE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:
Last Name:ANDERSON
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:PO BOX 1210
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72033-1210
Mailing Address - Country:US
Mailing Address - Phone:501-329-1800
Mailing Address - Fax:501-329-2507
Practice Address - Street 1:2710 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-6141
Practice Address - Country:US
Practice Address - Phone:501-329-1800
Practice Address - Fax:501-329-2507
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR123592363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily