Provider Demographics
NPI:1588653596
Name:BONIN, KATHLEEN (APRN)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:
Last Name:BONIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 TOWN ST STE 300
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2339
Mailing Address - Country:US
Mailing Address - Phone:860-886-0567
Mailing Address - Fax:860-886-0567
Practice Address - Street 1:42 TOWN ST STE 300
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2339
Practice Address - Country:US
Practice Address - Phone:860-886-0567
Practice Address - Fax:860-886-0567
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002975363L00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT400002975CT01OtherANTHEM BLUE CROSS
CTP3245483OtherOXFORD
CT004242848Medicaid
CT2V4906OtherHEALTH NET
CT102975OtherCONNECTICARE
CT400002975CT01OtherANTHEM BLUE CROSS
CT102975OtherCONNECTICARE