Provider Demographics
NPI:1952511396
Name:CONNOLLY, BONNIE LYNN (RNC, ANP)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:LYNN
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:RNC, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1536 OAKWOOD TER
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-8538
Mailing Address - Country:US
Mailing Address - Phone:651-785-0693
Mailing Address - Fax:
Practice Address - Street 1:327 CEDAR AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1030
Practice Address - Country:US
Practice Address - Phone:612-294-1333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 0812337363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health