Active NPI
Susan Marie Bonnell, PNP-PC
- Nurse Practitioner
- San Diego, CA
National Provider Identifier
1790886737
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 13301
- Practice address
- 4305 University Avenue
Suite 150
San Diego, CA 92105 - Phone
- (619) 563-0507
- Fax
- (619) 563-0015
- NPI assigned
- Sep 25, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | NP13301 | CA | |
| Nurse Practitioner | 363L00000X | 13301 | CA | Primary |
Addresses
Primary practice location
4305 University Avenue
Suite 150
San Diego, CA 92105
Mailing address
6910 Monte Verde Drive
San Diego, CA 92119
Phone (619) 698-6454
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)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13301 | CA | MD | Occupational Therapist |
| NP13301 | CA | MD | Pediatric Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159142400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1444348800000",
"number": "1790886737",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6910 MONTE VERDE DRIVE",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "92119",
"telephone_number": "619-698-6454",
"fax_number": "619-698-6388"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4305 UNIVERSITY AVENUE",
"address_2": "SUITE 150",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "92105",
"telephone_number": "619-563-0507",
"fax_number": "619-563-0015"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BONNELL",
"first_name": "SUSAN",
"middle_name": "MARIE",
"name_prefix": "Dr.",
"credential": "PNP-PC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-25",
"last_updated": "2015-10-09",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "CA",
"license": "NP13301",
"primary": false
},
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "CA",
"license": "13301",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.