Provider Demographics
NPI:1275717837
Name:HOLLINGSWORTH, BONNIE L (IBCLC, RLC, RN)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:L
Last Name:HOLLINGSWORTH
Suffix:
Gender:F
Credentials:IBCLC, RLC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 DOE RUN DR
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-2349
Mailing Address - Country:US
Mailing Address - Phone:405-265-3444
Mailing Address - Fax:405-271-6454
Practice Address - Street 1:OU PHYSICIANS
Practice Address - Street 2:825 N.E. 10TH STREET, OUPB 3300
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104
Practice Address - Country:US
Practice Address - Phone:405-271-9494
Practice Address - Fax:405-271-3727
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist