Bonnie Lea Mack, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

625810 Issued in TX

Practice address

90 Hope Dr
Mountain Home a F B, ID 83648-1057

Phone

(208) 828-7648

NPI assigned

Nov 15, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1132012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1276473600000",
    "number": "1598747701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1085 JULIA ST",
            "city": "MOUNTAIN HOME",
            "state": "ID",
            "postal_code": "836474687",
            "telephone_number": "208-599-0584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 HOPE DR",
            "city": "MOUNTAIN HOME A F B",
            "state": "ID",
            "postal_code": "836481057",
            "telephone_number": "208-828-7648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "BONNIE",
        "middle_name": "LEA",
        "name_prefix": "Mrs.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-15",
        "last_updated": "2010-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": "625810",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy Jo Hicks
• Jennifer Lynn Hudson, D.O.
• Joseph Paul Keddie, IDMT
• Kristen Anne Lewis
• Dane A. Looman, IDMT
• Brandi Adele Mackey, IDMT
• Jeffrie Neil Mayberry, IDMT
• Maria Elena Miller-Rinaldi, D.D.S.
• Steve A. Neff, MSW
• Eric Douglas Nielsen, O.D.

• Certified Registered Nurse Anesthetist in Mountain Home a F B, ID
• Providers in Mountain Home a F B, ID by specialty
• Certified Registered Nurse Anesthetist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.