Individual ProviderNicole BonarNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address2911 Medical Arts St Ste 10, Austin, TX 78705-3302(866) 473-0663(256) 565-2431PECOS EnrollmentBased on the most recent information from CMS, provider Nicole Bonar is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 6 days ago.Profile DetailsProvider ID1407471154Provider TypeIndividualFull NameBonar, NicoleCredentialCRNPGenderFemaleSole ProprietorNoEnumeration Date6/9/2020Last Updated6/9/2020Contact InformationPractice LocationPractice Address2911 Medical Arts St Ste 10, Austin, TX 78705-3302Phone(866) 473-0663FaxUnlisted FaxMailing LocationMailing Address1006 Home Depot Way Apt 5109, Bastrop, TX 78602-2974Phone(256) 565-2431FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseAP144520TexasCode163W00000XDescriptionRegistered NurseNursing Service ProvidersLicense870829TexasCode163WF0300XDescriptionRegistered NurseNursing Service ProvidersLicense7003754Texas