Provider Demographics
NPI:1205971546
Name:BONNER, KAREN M (NP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:BONNER
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:615 PENNSYLVANIA AVE
Mailing Address - Street 2:SHEBOYGAN COUNTY INHEALTH CLINIC
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-4642
Mailing Address - Country:US
Mailing Address - Phone:920-547-4210
Mailing Address - Fax:262-247-0662
Practice Address - Street 1:615 PENNSYLVANIA AVE
Practice Address - Street 2:SHEBOYGAN COUNTY INHEALTH CLINIC
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-4642
Practice Address - Country:US
Practice Address - Phone:920-547-4210
Practice Address - Fax:262-247-0662
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2008-05-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI1906-033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43968900Medicaid