Provider Demographics
NPI:1144255084
Name:BONNER, RACHEL (FNP)
Entity type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:
Last Name:BONNER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 DEPOT CT SE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-3017
Mailing Address - Country:US
Mailing Address - Phone:703-662-3004
Mailing Address - Fax:877-371-4164
Practice Address - Street 1:215 DEPOT CT SE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-3017
Practice Address - Country:US
Practice Address - Phone:703-662-3004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164448363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1144255084Medicaid
VAQ34336Medicare UPIN
VA1144255084Medicaid