Provider Demographics
NPI:1073946976
Name:BONHOMME, AILLISE B (LPN)
Entity Type:Individual
Prefix:MRS
First Name:AILLISE
Middle Name:B
Last Name:BONHOMME
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 1:322 W ELIZABETH AVE
Mailing Address - Street 2:APT. 1F
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-4250
Mailing Address - Country:US
Mailing Address - Phone:862-452-5489
Mailing Address - Fax:
Practice Address - Street 1:322 W ELIZABETH AVE
Practice Address - Street 2:APT. 1F
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-4250
Practice Address - Country:US
Practice Address - Phone:862-452-5489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2020-01-22
Deactivation Date:2019-09-27
Deactivation Code:
Reactivation Date:2020-01-22
Provider Licenses
StateLicense IDTaxonomies
NJ26NP06743000164W00000X
NJ26NR20187200163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse