Provider Demographics
NPI:1194851048
Name:BONNESEN, L. A
Entity Type:Individual
Prefix:
First Name:L.
Middle Name:A
Last Name:BONNESEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3310 W BELL RD
Mailing Address - Street 2:#249
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-2925
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3310 W BELL RD
Practice Address - Street 2:#249
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-2925
Practice Address - Country:US
Practice Address - Phone:602-280-2602
Practice Address - Fax:602-866-7759
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment