Provider Demographics
NPI:1275016677
Name:BONNER, DONNA FAYE (PCA)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:FAYE
Last Name:BONNER
Suffix:
Gender:F
Credentials:PCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 ELKS PEAK AVE.
Mailing Address - Street 2:121 ELKS PEAK AVE
Mailing Address - City:N. LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084
Mailing Address - Country:US
Mailing Address - Phone:661-444-9269
Mailing Address - Fax:
Practice Address - Street 1:121 ELKS PEAK AVE.
Practice Address - Street 2:121 ELKS PEAK AVE
Practice Address - City:N. LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084
Practice Address - Country:US
Practice Address - Phone:661-444-9269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant