Provider Demographics
NPI:1013217983
Name:BONKAT, TINA OVIGUE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:OVIGUE
Last Name:BONKAT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:AUGUSTINA
Other - Middle Name:
Other - Last Name:ERUAGBERE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1108 VILLAGE ROAD
Mailing Address - Street 2:APT 16D
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318
Mailing Address - Country:US
Mailing Address - Phone:952-688-2345
Mailing Address - Fax:
Practice Address - Street 1:6711 14TH AVENUE SOUTH
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55432
Practice Address - Country:US
Practice Address - Phone:952-688-2345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL64317-9164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse