Provider Demographics
NPI:1548891005
Name:GONZALES, BONNIE JANE (CNM)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:JANE
Last Name:GONZALES
Suffix:
Gender:
Credentials:CNM
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:
Other - Last Name:WANLASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:2057-2 WATCHMAN DRIVE
Mailing Address - Street 2:B2122
Mailing Address - City:FORT DEFIANCE
Mailing Address - State:AZ
Mailing Address - Zip Code:86504
Mailing Address - Country:US
Mailing Address - Phone:907-947-1206
Mailing Address - Fax:
Practice Address - Street 1:2057-2 WATCHMAN DRIVE
Practice Address - Street 2:B2122
Practice Address - City:FORT DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86504
Practice Address - Country:US
Practice Address - Phone:907-947-1206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-03
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife