Provider Demographics
NPI:1043548118
Name:OVITT, BONNIE SUMMERS (LPN)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:SUMMERS
Last Name:OVITT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 STEVENS LN
Mailing Address - Street 2:
Mailing Address - City:FORT EDWARD
Mailing Address - State:NY
Mailing Address - Zip Code:12828-1211
Mailing Address - Country:US
Mailing Address - Phone:518-747-8985
Mailing Address - Fax:
Practice Address - Street 1:9 STEVENS LN
Practice Address - Street 2:
Practice Address - City:FORT EDWARD
Practice Address - State:NY
Practice Address - Zip Code:12828-1211
Practice Address - Country:US
Practice Address - Phone:518-747-8985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196736-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse