Provider Demographics
NPI:1265846216
Name:NANOS, BONITA SUE (RN)
Entity Type:Individual
Prefix:MRS
First Name:BONITA
Middle Name:SUE
Last Name:NANOS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2103 OAKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-4026
Mailing Address - Country:US
Mailing Address - Phone:479-381-0052
Mailing Address - Fax:
Practice Address - Street 1:2103 OAKWOOD AVE
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-4026
Practice Address - Country:US
Practice Address - Phone:479-381-0052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR69573163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse