Provider Demographics
NPI:1245807080
Name:HAYES, BONITA ANISE (LPN)
Entity Type:Individual
Prefix:
First Name:BONITA
Middle Name:ANISE
Last Name:HAYES
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 1:41795 W 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-3107
Mailing Address - Country:US
Mailing Address - Phone:248-449-1655
Mailing Address - Fax:248-449-1637
Practice Address - Street 1:41795 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-3107
Practice Address - Country:US
Practice Address - Phone:248-449-1655
Practice Address - Fax:248-449-1637
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703058286164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse