Provider Demographics
NPI:1336864602
Name:BONOAN, RACHEL LEIGH (NP)
Entity Type:Individual
Prefix:MISS
First Name:RACHEL
Middle Name:LEIGH
Last Name:BONOAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14621 WESTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-1348
Mailing Address - Country:US
Mailing Address - Phone:216-870-7651
Mailing Address - Fax:
Practice Address - Street 1:6715 W 56TH AVE # 14-209
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-3215
Practice Address - Country:US
Practice Address - Phone:216-870-7651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0995965-N363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care