Provider Demographics
NPI:1073887253
Name:MOUNT, BONNIE KAY (RN)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:KAY
Last Name:MOUNT
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 1:622 MANZANO ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-6302
Mailing Address - Country:US
Mailing Address - Phone:505-925-4044
Mailing Address - Fax:
Practice Address - Street 1:622 MANZANO ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-6302
Practice Address - Country:US
Practice Address - Phone:505-925-4044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR54072163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health