Provider Demographics
NPI:1699453001
Name:BONDZIE, NANABANYIN
Entity type:Individual
Prefix:
First Name:NANABANYIN
Middle Name:
Last Name:BONDZIE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3567 RESERVE COMMONS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-5344
Mailing Address - Country:US
Mailing Address - Phone:330-664-9250
Mailing Address - Fax:
Practice Address - Street 1:3567 RESERVE COMMONS DR STE 100
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-5344
Practice Address - Country:US
Practice Address - Phone:330-664-9250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH458686163W00000X
WV117598363LP0808X
OH0034844363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse