Individual
MS. OLESEA BONANNO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
4004 KRUSE WAY PL STE 300, LAKE OSWEGO, OR 97035-2479
(503) 216-1500
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
10004854
OR
363LF0000X
Family Nurse Practitioner
ARNP9380372
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102291000
—
FL
01
—
K9170
MEDICARE
FL
Enumeration date
09/19/2018
Last updated
10/27/2023
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