Provider Demographics
NPI:1003426321
Name:BONKOWSKI, ALEXIA M (RN)
Entity Type:Individual
Prefix:
First Name:ALEXIA
Middle Name:M
Last Name:BONKOWSKI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18222 129TH PL NE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-3117
Mailing Address - Country:US
Mailing Address - Phone:206-617-5276
Mailing Address - Fax:
Practice Address - Street 1:11421 31ST DR SE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-5273
Practice Address - Country:US
Practice Address - Phone:206-617-5276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-01
Last Update Date:2020-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00171834163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse