Individual
JACOB BONNEMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2900 N LAKE SHORE DR, CHICAGO, IL 60657-5640
(773) 665-3000
Mailing address
2650 RIDGE AVE # 1223, EVANSTON, IL 60201-1700
(477) 335-3158
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041422907
IL
163W00000X
Registered Nurse
28281380A
IN
367500000X
Certified Registered Nurse Anesthetist
041422907
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
209028617
IL
Other
Enumeration date
05/11/2023
Last updated
03/07/2024
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