Provider Demographics
NPI:1427302595
Name:BONAR, THERESA ANN
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:ANN
Last Name:BONAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3845 BRANCH CREEK CT
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-7817
Mailing Address - Country:US
Mailing Address - Phone:317-753-3175
Mailing Address - Fax:
Practice Address - Street 1:3845 BRANCH CREEK CT
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-7817
Practice Address - Country:US
Practice Address - Phone:317-753-3175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000025A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health