Provider Demographics
NPI:1487616413
Name:HOPPER, BONNIE L (ARNP)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:L
Last Name:HOPPER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ELLIOT WAY
Mailing Address - Street 2:NEONATOLOGY SERVICES - ELLIOT HOSPITAL
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-3502
Mailing Address - Country:US
Mailing Address - Phone:603-663-2692
Mailing Address - Fax:603-663-3982
Practice Address - Street 1:1 ELLIOT WAY
Practice Address - Street 2:NEONATOLOGY SERVICES - ELLIOT HOSPITAL
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-3502
Practice Address - Country:US
Practice Address - Phone:603-663-2692
Practice Address - Fax:603-663-3982
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH024689-23-02363LN0000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0041674-00Medicaid
NH30966YOtherANTHEM REFERRING RAN
NH40Y008233NH01OtherANTHEM ACES #
NH30343492Medicaid
GA003113757AMedicaid
NH1046300OtherCIGNA
NH1046300OtherCIGNA
FL0041674-00Medicaid