Provider Demographics
NPI:1073022596
Name:HARRIS, BONNY LOU (LPN)
Entity Type:Individual
Prefix:
First Name:BONNY
Middle Name:LOU
Last Name:HARRIS
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 1:8767 NATIONAL RD SW LOT 43 N
Mailing Address - Street 2:
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062
Mailing Address - Country:US
Mailing Address - Phone:740-731-1594
Mailing Address - Fax:
Practice Address - Street 1:8764 NATIONAL RD SW LOT 43
Practice Address - Street 2:
Practice Address - City:PATASKALA
Practice Address - State:OH
Practice Address - Zip Code:43062
Practice Address - Country:US
Practice Address - Phone:740-731-1594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-27
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN096945-MEDS164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse