Provider Demographics
NPI:1326251950
Name:CLEMMER, BONNIE LLOYD (RN)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:LLOYD
Last Name:CLEMMER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:BONNA
Other - Middle Name:
Other - Last Name:CLEMMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6818 W CO RD 69
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707
Mailing Address - Country:US
Mailing Address - Phone:432-694-2388
Mailing Address - Fax:
Practice Address - Street 1:3600 W LOOP 250 NORTH
Practice Address - Street 2:APT 1083
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707
Practice Address - Country:US
Practice Address - Phone:432-889-8537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX436002163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health