Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | F306-155-1 | NY |
NPI | 1063858090 |
---|---|
Provider Name | Suzanne Elaine Bohnker |
First Address | New York, NY 10017-2803 |
Second Address | Saint Louis, MO 63141-6336 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2013 |
Last Update Date | 16/05/2013 |