Active NPI
Bonita Dicello
- Registered Nurse
- Eastlake, OH
National Provider Identifier
1174279699
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- RN.260720
- Practice address
- 37747 Willow Dr
Eastlake, OH 44095-1058 - Phone
- (614) 339-0806
- NPI assigned
- Feb 23, 2022
- Last updated
- Feb 23, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN.260720 | OH | Primary |
Addresses
Primary practice location
37747 Willow Dr
Eastlake, OH 44095-1058
Mailing address
7271 Engle Rd
Middleburg Heights, OH 44130-8488
Phone (216) 750-2600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2910854 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN.260720 | OH | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1645574400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1645574400000",
"number": "1174279699",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7271 ENGLE RD",
"city": "MIDDLEBURG HEIGHTS",
"state": "OH",
"postal_code": "441308488",
"telephone_number": "216-750-2600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "37747 WILLOW DR",
"city": "EASTLAKE",
"state": "OH",
"postal_code": "440951058",
"telephone_number": "614-339-0806"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DICELLO",
"first_name": "BONITA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-02-23",
"last_updated": "2022-02-23",
"certification_date": "2022-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "OH",
"license": "RN.260720",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2910854",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Eastlake, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.