Provider Demographics
NPI:1124571567
Name:BOUDAKIAN, BONNIE JEANNE (RN, BSN)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:JEANNE
Last Name:BOUDAKIAN
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 S PARKER RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-2910
Mailing Address - Country:US
Mailing Address - Phone:720-577-1804
Mailing Address - Fax:720-577-1803
Practice Address - Street 1:3033 S PARKER RD
Practice Address - Street 2:SUITE 300
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-2910
Practice Address - Country:US
Practice Address - Phone:720-577-1804
Practice Address - Fax:720-577-1803
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1637831163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health