MARY T. BONACCORSI


Address: 903 Mineral Point Ave, Janesville, WI 53548-2970
Phone: (608) 756-5555

MARY T. BONACCORSI (NPI# 1811927205) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1811927205
Entity Type Individual
Full Name MARY T. BONACCORSI
Credential APRN, DNP, FNP
Practice Address 903 Mineral Point Ave
Janesville
WI 53548-2970
Practice Telephone (608) 756-5555
Practice Fax Number 6087560174
Mailing Telephone (608) 756-5555
Mailing Fax Number 6087560174
Enumeration Date 2006-07-03
Last Update Date 2017-06-14
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 363LF0000X Nurse Practitioner
Specialization: Family
2628-033 WI Physician Assistants & Advanced Practice Nursing Providers
N 363LF0000X Nurse Practitioner
Specialization: Family
209004213 IL Physician Assistants & Advanced Practice Nursing Providers
Y 363LP0808X Nurse Practitioner
Specialization: Psych/Mental Health
2628-33 WI Physician Assistants & Advanced Practice Nursing Providers

Other Provider Identifier

State Issuer Identifier Type Code
WI WI MEDICARE 000054176-K400333954 01
WI 1811927205 05
PTAN 406120105 01
WI MERCYCARE INSURANCE BONACMAR 01
WI WI MEDICARE 000084908-K400332994 01
IL 041305302 05
WI BCBSWI 1811927205 01

Office Location

Street Address 903 MINERAL POINT AVE
City JANESVILLE
State WI
Zip Code 53548-2970

Providers in the same location

NPI Name Taxonomy Address Enumeration
1417581745 Tanya N. Olin Registered Nurse 903 Mineral Point Ave, Janesville, WI 53548-2970 2020-02-25
1396391728 Briann N. Modos Registered Nurse 903 Mineral Point Ave, Janesville, WI 53548-2970 2019-08-12
1114579364 Jessica A. Wallace Registered Nurse 903 Mineral Point Ave, Janesville, WI 53548-2970 2019-07-09
1811403769 Rachel V. Sanderson Counselor 903 Mineral Point Ave, Janesville, WI 53548-2970 2017-12-14
1972038958 Shelby L. Kandziora Counselor 903 Mineral Point Ave, Janesville, WI 53548-2970 2017-04-27
1093255929 Ashley A. Crull Psychologist 903 Mineral Point Ave, Janesville, WI 53548 2017-02-25
1639617855 Stacy M. Condon Social Worker 903 Mineral Point Ave, Janesville, WI 53548-2970 2017-02-08
1841744216 Kelly A. Janes Counselor 903 Mineral Point Ave, Janesville, WI 53548-2970 2016-08-15
1366892044 Sara J Maly Counselor 903 Mineral Point Ave, Janesville, WI 53548-2970 2016-06-14
1033570882 Rebecca L Davis Counselor 903 Mineral Point Ave, Janesville, WI 53548-2970 2016-03-08
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1578846010 Patricia Ann Sheets Licensed Vocational Nurse 316 N. Terrace St., Janbesville, WI 53548 2011-09-21
1760658983 Kristy Kay Prentice Kerl Dental Hygienist 121 Jonathon Dr, Janesville, WI 53548 2008-05-07
1316005978 City of Janesville Emergency Medical Technician, Paramedic 18 N Jackson St, Janesville, WI 53548 2006-12-05
1558464115 Sarah Louise Hessenauer Social Worker 17 S. River St, Suite 254, Janesville, WI 53548 2006-09-07
1073548327 Mary Katherine Cefalu Registered Nurse 17 S. River, Suite 254, Janesville, WI 53548 2006-07-12
1699707950 Gary Lavern Jones Counselor 175 River, Suite 254, Janesville, WI 53548 2006-07-07
1295767424 Michael Stuart Kaye Clinical Neuropsychologist 17 S River St Ste 254, Janesville, WI 53548 2006-07-07
1205864055 Amy Laurie Roy Counselor 17 S River Suite 254, Janesville, WI 53548 2006-06-29
1518903566 Leota I Larson Psychologist 17 S River, Suite 254, Janesville, WI 53548 2006-06-20
1760950414 North Star Chiropractic LLC Chiropractor 21 S Jackson St, Ste 160, Janesville, WI 53548 2018-11-10
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Taxonomy Information

Taxonomy Code 363LP0808X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Psych/Mental Health

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1962773648 Clark Carroll Nurse Practitioner 1820 Center Ave, Janesville, WI 53546 2012-01-26
1346605680 Linda E Callahan Nurse Practitioner 1000 Mineral Point Ave, Janesville, WI 53548 2015-12-30
1710353651 Audrey Marian Addaquay-corey Nurse Practitioner 903 Mineral Point Ave, Janesville, WI 53548-2970 2015-08-14
1194705988 Teresa A Terrill Nurse Practitioner 1 S Main St, Janesville, WI 53545-3922 2006-01-18

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1003422726 Wisconsin Healthcare Family Practices and Behavioral Services LLC Nurse Practitioner 10721 W Capitol Dr Ste G103, Wauwatosa, WI 53222-1210 2020-09-17
1689292856 Julianne Margaret John Nurse Practitioner 3237 S 16th St Ste 310, Milwaukee, WI 53215-4526 2020-07-13
1356968002 Marisa Hiley Nurse Practitioner W129 N7055 Northfield Drive, Menomonee Falls, WI 53051 2020-06-29
1932726700 Lauren Marie Skemp Nurse Practitioner 1960 Hyview Rd, Cuba City, WI 53807-9718 2020-06-28
1235779240 Conscious Practice, LLC Nurse Practitioner 119 19th St N, La Crosse, WI 54601-3724 2020-01-08
1073152161 Stephanie L Ruskell Nurse Practitioner 3805 Spring St Ste 240, Mount Pleasant, WI 53405-1667 2020-01-06
1558924811 Sarah Kathryn Garven Nurse Practitioner 5000 West National Ave Rm 3119, Milwaukee, WI 53295-1000 2019-04-22
1104394535 Therese Ann Alm Nurse Practitioner 383 Williamstowne Ste 101, Delafield, WI 53018-2332 2018-11-03
1477079242 Aeron Rachel Adams Nurse Practitioner W10237 Lake Emily Rd, Fox Lake, WI 53933 2017-08-14
1396140398 Monica Gorski Nurse Practitioner 505 King St Ste 218, La Crosse, WI 54601-4289 2014-11-03
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Competitor

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City JANESVILLE
Zip Code 53548

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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