Provider Demographics
NPI:1083055297
Name:HALK, BONNIE W (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:W
Last Name:HALK
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 CHANDLER AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-2924
Mailing Address - Country:US
Mailing Address - Phone:718-981-2871
Mailing Address - Fax:
Practice Address - Street 1:73 CHANDLER AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-2924
Practice Address - Country:US
Practice Address - Phone:718-981-2871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11181475163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant