Provider Demographics
NPI:1326426909
Name:KNICE BONNER
Entity Type:Organization
Organization Name:KNICE BONNER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSE PRACTICAL NURSING
Authorized Official - Prefix:MS
Authorized Official - First Name:KNICE
Authorized Official - Middle Name:
Authorized Official - Last Name:BONNER
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:513-338-3165
Mailing Address - Street 1:3347 EVANSTON AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45207
Mailing Address - Country:US
Mailing Address - Phone:513-338-3165
Mailing Address - Fax:
Practice Address - Street 1:3347 EVANSTON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45207-1914
Practice Address - Country:US
Practice Address - Phone:513-338-3165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH153962311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home