Provider Demographics
NPI:1154860807
Name:CALLAGHAN, BONNIE LEE (LPN)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:LEE
Last Name:CALLAGHAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:BONNIE
Other - Middle Name:LEE
Other - Last Name:WELDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:3855 BLAIR MILL RD
Mailing Address - Street 2:APT#238A
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-2815
Mailing Address - Country:US
Mailing Address - Phone:267-596-7449
Mailing Address - Fax:
Practice Address - Street 1:3855 BLAIR MILL RD
Practice Address - Street 2:APT#238A
Practice Address - City:HORSHAM
Practice Address - State:PA
Practice Address - Zip Code:19044-2815
Practice Address - Country:US
Practice Address - Phone:267-596-7449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN061472L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse