Provider Demographics
NPI:1881072924
Name:MITCHELL, BONNIE KAYE (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:KAYE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21660 W FIELD PKWY
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60010-7265
Mailing Address - Country:US
Mailing Address - Phone:888-803-3370
Mailing Address - Fax:
Practice Address - Street 1:21660 W FIELD PKWY
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:IL
Practice Address - Zip Code:60010-7265
Practice Address - Country:US
Practice Address - Phone:888-803-3370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-08
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8623-33363L00000X
IAA151788363L00000X
IL277001567363LF0000X
IL377001567363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily