Provider Demographics
NPI:1982947891
Name:BONATI, LAUREN M (M)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:M
Last Name:BONATI
Suffix:
Gender:F
Credentials:M
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:MESHKIV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2606
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632-2606
Mailing Address - Country:US
Mailing Address - Phone:970-926-1800
Mailing Address - Fax:888-505-2650
Practice Address - Street 1:105 EDWARDS VILLAGE BOULEVARD
Practice Address - Street 2:G211
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632-3211
Practice Address - Country:US
Practice Address - Phone:970-926-1800
Practice Address - Fax:888-505-2650
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0060623207N00000X, 207ND0101X
FL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program