CARISSA ANN BONNER PNP NPI 1699078170

NPI Information

  • NPI: 1699078170
  • Provider Name: CARISSA ANN BONNER, PNP
  • Classification: Nurse Practitioner - 363LP0200X
  • Specialization: Pediatrics
  • Entity Type: Individual
  • Address: 9249 W LAKE CITY RD
    HOUGHTON LAKE, MI
    ZIP 48629
  • Phone: (989) 422-5122

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NPI Details

Carissa Ann Bonner, PNP is a pediatrics nurse practitioner in Houghton Lake, MI. Carissa Ann Bonner, PNP NPI is 1699078170. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

9249 W LAKE CITY RD
HOUGHTON LAKE, MI
ZIP 48629-602
Phone: (989) 422-5122
Fax: (989) 422-4378

The enumeration date for this NPI number is 12/6/2010 and was last updated on 3/20/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LP0200XNurse PractitionerPediatrics4704250132MICHIGANYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1G27604075MEDICARE PINMICHIGAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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