Provider Demographics
NPI:1235203696
Name:ARNTZ, BONNIE JEAN (OTR)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:JEAN
Last Name:ARNTZ
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3585
Mailing Address - Street 2:
Mailing Address - City:CAMDENTON
Mailing Address - State:MO
Mailing Address - Zip Code:65020-3585
Mailing Address - Country:US
Mailing Address - Phone:573-348-4004
Mailing Address - Fax:573-348-3272
Practice Address - Street 1:5816 HIGHWAY 54
Practice Address - Street 2:SUITE 103A
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-3046
Practice Address - Country:US
Practice Address - Phone:573-348-4004
Practice Address - Fax:573-348-3272
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004549174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO34010OtherHEALTHCARE USA
MO152615OtherBCBS