Provider Demographics
NPI:1467336032
Name:BONIFAS, KELLY JEAN (RN)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:JEAN
Last Name:BONIFAS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:JEAN
Other - Last Name:BREHM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1090 S ADAMS CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-7458
Mailing Address - Country:US
Mailing Address - Phone:402-463-3285
Mailing Address - Fax:402-463-6344
Practice Address - Street 1:1090 S ADAMS CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-7458
Practice Address - Country:US
Practice Address - Phone:402-463-3285
Practice Address - Fax:402-462-6344
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE64460163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool