Provider Demographics
NPI:1649901612
Name:BONAVITA, CHRISTINE (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:BONAVITA
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2989 RAMS HORN RUN
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023-8024
Mailing Address - Country:US
Mailing Address - Phone:720-464-6555
Mailing Address - Fax:
Practice Address - Street 1:2989 RAMS HORN RUN
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80023-8024
Practice Address - Country:US
Practice Address - Phone:720-464-6555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COL-143980163WL0100X
CORN-0200405163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant