Provider Demographics
NPI:1366185993
Name:BONIN, EILEEN ANNETTE (APRN)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:ANNETTE
Last Name:BONIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:GRANT
Mailing Address - State:NE
Mailing Address - Zip Code:69140-3095
Mailing Address - Country:US
Mailing Address - Phone:308-352-7200
Mailing Address - Fax:308-352-7290
Practice Address - Street 1:221 E 10TH ST
Practice Address - Street 2:
Practice Address - City:OGALLALA
Practice Address - State:NE
Practice Address - Zip Code:69153-1425
Practice Address - Country:US
Practice Address - Phone:308-284-8421
Practice Address - Fax:308-284-2821
Is Sole Proprietor?:No
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE114133363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner