Provider Demographics
NPI:1770708927
Name:BONNER, LAURA L (CRNFA)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:L
Last Name:BONNER
Suffix:
Gender:F
Credentials:CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 LONE STAR LN
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-4535
Mailing Address - Country:US
Mailing Address - Phone:817-480-1000
Mailing Address - Fax:817-251-0180
Practice Address - Street 1:2521 LONE STAR LN
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-4535
Practice Address - Country:US
Practice Address - Phone:817-480-1000
Practice Address - Fax:817-251-0180
Is Sole Proprietor?:No
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX537082364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX056084OtherCERTIFICATION # - RNFA