Provider Demographics
NPI:1891285854
Name:BONOWSKI, KELLEY M (DNP, RN, CPNP-PC)
Entity type:Individual
Prefix:DR
First Name:KELLEY
Middle Name:M
Last Name:BONOWSKI
Suffix:
Gender:F
Credentials:DNP, RN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 W THUNDERBIRD RD STE 301
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4710
Mailing Address - Country:US
Mailing Address - Phone:602-865-4442
Mailing Address - Fax:
Practice Address - Street 1:5310 W THUNDERBIRD RD STE 301
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4710
Practice Address - Country:US
Practice Address - Phone:602-865-4442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-15
Last Update Date:2019-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN109394363LP0200X
AZAP11360363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics