Provider Demographics
NPI:1326548017
Name:ORTIZ, BONNIE (LVN)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-3316
Mailing Address - Country:US
Mailing Address - Phone:512-797-8728
Mailing Address - Fax:
Practice Address - Street 1:845 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-3316
Practice Address - Country:US
Practice Address - Phone:512-797-8728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX329935164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse