Provider Demographics
NPI:1649869918
Name:BONMAN, AMI D (RN)
Entity type:Individual
Prefix:MRS
First Name:AMI
Middle Name:D
Last Name:BONMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W TAZEWELL ST APT 202
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1317
Mailing Address - Country:US
Mailing Address - Phone:205-886-4067
Mailing Address - Fax:
Practice Address - Street 1:2981 S MILITARY HWY
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23323-5810
Practice Address - Country:US
Practice Address - Phone:757-558-9830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001295574163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA12345983OtherCVSREQUIREDMETOFILLTHISOUT