Provider Demographics
NPI:1134512866
Name:MACKEY, BONNIE SUSANNAH (RN)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:SUSANNAH
Last Name:MACKEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:BONNIE
Other - Middle Name:SUSANNAH
Other - Last Name:SHERER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18018 N 45TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-1521
Mailing Address - Country:US
Mailing Address - Phone:317-490-1124
Mailing Address - Fax:
Practice Address - Street 1:18018 N 45TH PL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-1521
Practice Address - Country:US
Practice Address - Phone:317-490-1124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTRN190693286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital