Provider Demographics
NPI:1043781198
Name:BONNEY, EVELYN (HHA/CNA/GNA/CMT)
Entity Type:Individual
Prefix:MISS
First Name:EVELYN
Middle Name:
Last Name:BONNEY
Suffix:
Gender:F
Credentials:HHA/CNA/GNA/CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 SAINT MICHAELS DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-1960
Mailing Address - Country:US
Mailing Address - Phone:301-503-9748
Mailing Address - Fax:
Practice Address - Street 1:761 SAINT MICHAELS DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-1960
Practice Address - Country:US
Practice Address - Phone:301-503-9748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00133289374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide