Basic Information
Provider Information
NPI: 1114266541
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BONOW
FirstName: BROOKE
MiddleName: E.
NamePrefix: MS.
NameSuffix:  
Credential: APRN, FNP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 635283
Address2:  
City: CINCINNATI
State: OH
PostalCode: 452635283
CountryCode: US
TelephoneNumber: 8599127211
FaxNumber: 8596558981
Practice Location
Address1: 125 SAINT MICHAEL DR
Address2:  
City: COLD SPRING
State: KY
PostalCode: 41076
CountryCode: US
TelephoneNumber: 8597814111
FaxNumber: 8594415214
Other Information
ProviderEnumerationDate: 02/05/2013
LastUpdateDate: 08/31/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X3007817KYY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 
363LF0000X3007817KYN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
363LF0000X330723OHN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

ID Information
IDTypeStateIssuerDescription
008052405OH MEDICAID
710023969005KY MEDICAID
P0151672901KYRR MEDICAREOTHER


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