Provider Demographics
NPI:1215123625
Name:WILSON, BONITA ANN (ARNP-C)
Entity type:Individual
Prefix:
First Name:BONITA
Middle Name:ANN
Last Name:WILSON
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11480 S SHAWNEE HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:OVERBROOK
Mailing Address - State:KS
Mailing Address - Zip Code:66524-9244
Mailing Address - Country:US
Mailing Address - Phone:785-836-3210
Mailing Address - Fax:
Practice Address - Street 1:534 S KANSAS AVE
Practice Address - Street 2:SUITE 800
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66603-3451
Practice Address - Country:US
Practice Address - Phone:913-727-3235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45420363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily