Provider Demographics
NPI:1205015807
Name:MULLINS, BONNIE SUE (LPN,)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:SUE
Last Name:MULLINS
Suffix:
Gender:F
Credentials:LPN,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2665 FIVE POINTS RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:45640-9532
Mailing Address - Country:US
Mailing Address - Phone:740-286-7153
Mailing Address - Fax:
Practice Address - Street 1:2665 FIVE POINTS RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-9532
Practice Address - Country:US
Practice Address - Phone:740-286-7153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-091944164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse