Provider Demographics
NPI:1831818483
Name:ANDERSON, BONNIE (APRN FNP-C)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:APRN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 SILVERCREEK DR
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-4865
Mailing Address - Country:US
Mailing Address - Phone:717-278-7574
Mailing Address - Fax:
Practice Address - Street 1:5208 TENNYSON PKWY STE 100
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-7183
Practice Address - Country:US
Practice Address - Phone:844-464-1611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX884415363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily