Provider Demographics
NPI:1548292667
Name:CROSS, BONNIE J (APN)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:J
Last Name:CROSS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 516
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62439
Mailing Address - Country:US
Mailing Address - Phone:618-943-2609
Mailing Address - Fax:618-943-6409
Practice Address - Street 1:RR #3 BOX 414
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62439
Practice Address - Country:US
Practice Address - Phone:618-943-2609
Practice Address - Fax:618-943-6409
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL088856OtherHEALTH ALLIANCE INS
IL5132004OtherBCBS
1729885OtherFIRST HEALTH
IL618844OtherHEALTHLINK INS
IL376006178007Medicaid
838915OtherUNITED HEALTHCARE
IL618844OtherHEALTHLINK INS
IL143951Medicare Oscar/Certification