Provider Demographics
NPI:1386250710
Name:BONNER, LYDIA M (NP)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:M
Last Name:BONNER
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 1:1328 OLD STAGE RD
Mailing Address - Street 2:
Mailing Address - City:REPTON
Mailing Address - State:AL
Mailing Address - Zip Code:36475-9433
Mailing Address - Country:US
Mailing Address - Phone:251-593-1227
Mailing Address - Fax:833-760-3746
Practice Address - Street 1:1328 OLD STAGE RD
Practice Address - Street 2:
Practice Address - City:REPTON
Practice Address - State:AL
Practice Address - Zip Code:36475-9433
Practice Address - Country:US
Practice Address - Phone:251-593-1227
Practice Address - Fax:833-760-3746
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2025-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL115121363LF0000X
AL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center