Provider Demographics
NPI:1164037057
Name:BONSALL, ALAN CAIRNS
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:CAIRNS
Last Name:BONSALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6517 OLD MAGNOLIA LN
Mailing Address - Street 2:
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-8117
Mailing Address - Country:US
Mailing Address - Phone:980-474-9035
Mailing Address - Fax:
Practice Address - Street 1:10127 MISTY MOSS CT
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-8120
Practice Address - Country:US
Practice Address - Phone:704-779-4382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
3747A0650XOtherCARE GIVER