Provider Demographics
NPI:1972761278
Name:MOHLER, BONNIE L (CNP)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:L
Last Name:MOHLER
Suffix:
Gender:F
Credentials:CNP
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 36329
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44735-6329
Mailing Address - Country:US
Mailing Address - Phone:330-493-1480
Mailing Address - Fax:330-493-6805
Practice Address - Street 1:4665 BELPAR ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-3602
Practice Address - Country:US
Practice Address - Phone:330-493-1480
Practice Address - Fax:330-493-6805
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP08911363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0197338Medicaid
MONP29801Medicare PIN