Individual provider Active NPI

Bonnie Jane Gonzales, CNM

  • Advanced Practice Midwife
  • Fort Defiance, AZ
National Provider Identifier
1548891005
Registry record updated Aug 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Advanced Practice MidwifeTaxonomy code 367A00000X
Practice address
Corner of Route N12 and N7
Fort Defiance, AZ 86504
Phone
(928) 729-8000
NPI assigned
Feb 3, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 24, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Advanced Practice Midwife 367A00000X Primary

Addresses

Primary practice location

Corner of Route N12 and N7
Fort Defiance, AZ 86504

Mailing address

PO Box 649
Fort Defiance, AZ 86504-0649
Phone (928) 729-8000

Other names 1

  • Bonnie Wanlass Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO, TX2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200310002416 CO Practitioner - Certified Nurse Midwife (CNM) 7416385273 Reassigns benefits to 1 organization
I20210702000148 TX Practitioner - Certified Nurse Midwife (CNM) 7416385273 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife

Practice roles

OrganizationSpecialtyStatusNew patients
Intermountain Medical Group Denver, LLC Current Accepting new patients
Intermountain Medical Group Denver, LLC CurrentSince Aug 9, 2020 Accepting new patients
The Fort Defiance Indian Hospital Board, Incorporation CurrentSince Jul 12, 2021 Accepting new patients
Intermountain Medical Group Denver, LLC CurrentSince Aug 9, 2020 Accepting new patients

Locations

500 Eldorado Blvd
Ste 6300
Broomfield, CO 80021
Phone (303) 272-0803

1375 E 19th Ave
Denver, CO 80218
Phone (303) 812-2000

1960 N Ogden St
Ste 320
Denver, CO 80218
Phone (303) 318-2620

4859 Yampa St
Denver, CO 80249
Phone (303) 498-1885

1960 N Ogden St
Ste 330
Denver, CO 80218
Phone (303) 318-2610

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1580688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787529600000",
    "number": "1548891005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 649",
            "city": "FORT DEFIANCE",
            "state": "AZ",
            "postal_code": "865040649",
            "telephone_number": "928-729-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CORNER OF ROUTE N12 AND N7",
            "city": "FORT DEFIANCE",
            "state": "AZ",
            "postal_code": "86504",
            "telephone_number": "928-729-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALES",
        "first_name": "BONNIE",
        "middle_name": "JANE",
        "credential": "CNM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-02-03",
        "last_updated": "2026-08-24",
        "certification_date": "2026-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BONNIE",
            "last_name": "WANLASS",
            "credential": "CNM",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Fort Defiance, AZ

Sources for this page

Verify at the official NPI Registry.