Provider Demographics
NPI:1235698648
Name:BONILLA REYES, MARIA ELENA (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ELENA
Last Name:BONILLA REYES
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2586 7TH AVE E STE 302
Mailing Address - Street 2:
Mailing Address - City:NORTH ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55109-3090
Mailing Address - Country:US
Mailing Address - Phone:651-633-7300
Mailing Address - Fax:
Practice Address - Street 1:2586 7TH AVE E STE 302
Practice Address - Street 2:
Practice Address - City:NORTH ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55109-3090
Practice Address - Country:US
Practice Address - Phone:651-633-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2263191163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health