Provider Demographics
NPI:1912669938
Name:BONELLO, CORTNEY (FNP-BC)
Entity type:Individual
Prefix:
First Name:CORTNEY
Middle Name:
Last Name:BONELLO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:CORTNEY
Other - Middle Name:
Other - Last Name:FORTUNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:59584 ACORN DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48094-1254
Mailing Address - Country:US
Mailing Address - Phone:586-291-0096
Mailing Address - Fax:
Practice Address - Street 1:1560 E MAPLE RD STE 290
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1135
Practice Address - Country:US
Practice Address - Phone:248-749-6630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704348293363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily