Provider Demographics
NPI:1184118135
Name:WILLOUGHBY, BONNIE JEAN (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:JEAN
Last Name:WILLOUGHBY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MISS
Other - First Name:BONNIE
Other - Middle Name:WILLOUGHBY
Other - Last Name:SKIADIOTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:404 HATFIELD CT
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-1126
Mailing Address - Country:US
Mailing Address - Phone:910-738-3358
Mailing Address - Fax:910-738-9174
Practice Address - Street 1:404 HATFIELD CT
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358
Practice Address - Country:US
Practice Address - Phone:910-738-3358
Practice Address - Fax:910-738-9174
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5010638363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner