MS. BONNIE L CLARK (NPI# 1063563310) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063563310 |
| Entity Type | Individual |
| Full Name | MS. BONNIE L CLARK |
| Other Name | MRS. BONNIE L.C. JACKSON |
| Credential | WHNP-BC |
| Practice Address |
5 Silver Rdg Veazie ME 04401-7086 |
| Practice Telephone | 2079420824 |
| Practice Fax Number | 2079420824 |
| Mailing Telephone | 2079420824 |
| Mailing Fax Number | 2079420824 |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2013-06-26 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LW0102X |
Nurse Practitioner Specialization: Women's Health |
CNP81695 | ME | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ME | MAINE STATE BOARD OF NURSING | CNP81695 | 01 |
| ME | MAINE STATE BOARD OF NURSING | RN18038 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104173822 | Bonnie J Clark | Licensed Practical Nurse | 47 Caton Rd, Corning, NY 14830-3741 | 2012-08-13 |
| 1306134341 | Bonnie Kathleen Clark | Physical Therapist | 197 E Broadway St, Danville, IN 46122-1803 | 2011-07-12 |
| 1710074570 | Bonnie Lou Clark | Nurse Practitioner | 200 East Main Avenue, Suite 202, Bismarck, ND 58501 | 2006-10-05 |
| 1063989960 | Bonnie Clark | Counselor | 20370 Poe Sholes Dr, Bend, OR 97703-7938 | 2018-10-29 |
| 1831472133 | Bonnie Lou Clark | Nurse Practitioner | 1319 Duncan Ave, Jeffersonville, IN 47130-3759 | 2011-09-22 |
| 1306124540 | Bonnie Clark | Pharmacist | 3200 Vine St, Cincinnati, OH 45220-2213 | 2011-07-21 |
| 1770700130 | Bonnie Clark | Social Worker | 280 Princeton Avenue Ext, Corning, NY 14830-1524 | 2007-04-19 |
| 1376672428 | Bonnie Clark | Licensed Psychiatric Technician | 1680 Walden Ave, Cheektowaga, NY 14225-4914 | 2007-03-05 |
| 1154355204 | Bonnie B Clark | Nurse Practitioner | 1380 E Medical Center Dr, Suite 1500, St George, UT 84790-2123 | 2006-07-11 |
| 1508899170 | Bonnie Clark | Physician Assistant | 5400 Gibson Blvd Se, Albuquerque, NM 87108-4729 | 2006-07-08 |
| Street Address |
5 SILVER RDG |
| City | VEAZIE |
| State | ME |
| Zip Code | 04401-7086 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184222523 | Bj's Wholesale Club Inc. | Eyewear Supplier (Equipment, not the service) | 110 Longview Dr, Bangor, ME 04401 | 2020-10-16 |
| 1033737937 | Daniel John Phulman | Counselor | 202 Exchange Street, Bangor, ME 04401 | 2020-07-08 |
| 1770104358 | Elizabeth Sarah Caruson | Physician Assistant | 417 State Street Webber Medical Building, East St, Ste. 121, Bangor, ME 04401 | 2020-05-05 |
| 1053961300 | Erika Dean | Occupational Therapist | 84 Sylvan Rd., Bangor, ME 04401 | 2019-09-18 |
| 1942853635 | Wildworks Therapy, Pllc | Occupational Therapist | 123 Mt Hope Ave, Bangor, ME 04401 | 2019-07-22 |
| 1255999173 | Jessica Arbisi | Physician Assistant | 1 Northeast Drive, Bangor, ME 04401 | 2019-06-05 |
| 1699232041 | Ehab Khamis Elhefnawi | Anesthesiology | Emmc Anesthesia Professional Service, 489 State Street, Bangor, ME 04401 | 2019-02-21 |
| 1477028884 | Zvorufura Makura | Otolaryngology | 885 Union Street, Ste 145, Bangor, ME 04401 | 2018-10-11 |
| 1255826541 | Lindsey M Fields | Optometrist | 955 Broadway Eye Center Northeast Dba Northeast Eyecare, Bangor, ME 04401 | 2018-06-28 |
| 1992211338 | Debra J Mcintyre | Counselor | 157 Park Street, #5, Bangor, ME 04401 | 2017-12-21 |
| Find all providers in zip 04401 | ||||
| Taxonomy Code | 363LW0102X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Women's Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760739650 | Yanghee Courbron | Nurse Practitioner | 100 Brickhill Ave Ste 203, South Portland, ME 04106-1999 | 2012-08-09 |
| 1215216643 | Sarah Jane Norris | Nurse Practitioner | 29 City Point Rd, Peaks Island, ME 04108-1161 | 2011-08-16 |
| 1730485483 | Amber Lynn Berube | Nurse Practitioner | 31 Crossridge Dr, Windham, ME 04062-5568 | 2011-01-27 |
| 1982837019 | Bronwyn Elizabeth Sewell | Nurse Practitioner | 443 Congress St Fl 2, Portland, ME 04101-3531 | 2009-08-24 |
| 1164632014 | Margaret Anna Mcgalliard | Nurse Practitioner | 12 Stillwater Ave Ste 1, Bangor, ME 04401-3984 | 2007-05-22 |
| 1720106362 | Kennebec Valley Community Action Program | Nurse Practitioner | 101 Water St, Suite 204, Waterville, ME 04901-6339 | 2007-03-26 |
| 1538245097 | Christina Rose Theriault | Nurse Practitioner | 139 Market St, Fort Kent, ME 04743-1410 | 2006-10-27 |
| 1144320300 | Jessie M. Reighley | Nurse Practitioner | 3 Marina Rd, Yarmouth, ME 04096-6783 | 2006-09-25 |
| 1497780613 | Susan E Eastler | Nurse Practitioner | 200 Livermore Falls Rd, Farmington, ME 04938-6244 | 2006-07-12 |
| 1356373005 | Priscilla Ann Perry | Nurse Practitioner | 68 Mount Hope Ave, Bangor, ME 04401-4096 | 2006-07-06 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.