Harley Bonniville, CPNP-PC

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

0024184256 Issued in VA

Practice address

119 Bulifants Blvd
Williamsburg, VA 23188-5747

Phone

(757) 564-7337

NPI assigned

Oct 11, 2022

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)

Not enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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.

• Childrens Medical Group Inc

  • Pediatrics Physician
  • Virginia Beach, VA
  • NPI 1366597114
  NPD (past)
• Childrens Medical Group Inc

  • Pediatrics Physician
  • Williamsburg, VA
  • NPI 1447305057
  NPD (past)

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

{
    "created_epoch": "1665446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665446400000",
    "number": "1700501830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2513 SPRING BRIDGE PL",
            "city": "SANDSTON",
            "state": "VA",
            "postal_code": "231504409",
            "telephone_number": "804-971-3420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 BULIFANTS BLVD",
            "city": "WILLIAMSBURG",
            "state": "VA",
            "postal_code": "231885747",
            "telephone_number": "757-564-7337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONNIVILLE",
        "first_name": "HARLEY",
        "credential": "CPNP-PC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-11",
        "last_updated": "2022-10-11",
        "certification_date": "2022-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "VA",
            "license": "0024184256",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Leight Bolam, COTA/L
• Mary Angela Boland, LCP
• Stacy Kline Bolling, LPC
• Janis Bolton, LCSW
• David Thompson Bond, PSY.D
• Kevina Boone, PMHNP
• Christopher Boop
• Christopher G. Boquist, MD
• Susanna Bose, WHNP-BC
• Sarah E Bott, P.A.

• Pediatric Nurse Practitioner in Williamsburg, VA
• Providers in Williamsburg, VA by specialty
• Pediatric Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 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.

Verify at the official NPI Registry.