NPI 1699078170 · live from the CMS NPI Registry
Carissa Ann Bonner, PNP
Nurse Practitioner, Pediatrics in Houghton Lake, MI. National Provider Identifier 1699078170, active.
NPI record
| NPI | 1699078170 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Nurse Practitioner, Pediatrics 363LP0200X |
| Practice location | 9249 W Lake City Rd, Houghton Lake, MI 48629 |
| Practice phone | 989-422-5122 |
| Enumerated | December 6, 2010 |
| Last updated | March 20, 2015 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Nurse Practitioner, Pediatrics primary | 363LP0200X | 4704250132 (MI) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.