Provider Demographics
NPI:1881072924
Name:WICHMAN, BONNIE MITCHELL (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:MITCHELL
Last Name:WICHMAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MS
Other - First Name:BONNIE
Other - Middle Name:KAYE
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:161 NATOMA ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94105-3746
Mailing Address - Country:US
Mailing Address - Phone:619-648-1247
Mailing Address - Fax:
Practice Address - Street 1:98 VENICE AVE
Practice Address - Street 2:
Practice Address - City:FOX LAKE
Practice Address - State:IL
Practice Address - Zip Code:60020-1534
Practice Address - Country:US
Practice Address - Phone:847-722-4880
Practice Address - Fax:847-654-0034
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-08
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA151788363L00000X
WI8623-33363L00000X
IL277001567363L00000X
IL377001567363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner