Provider Demographics
NPI:1346436938
Name:LASTER, BONNIE L (CFO)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:L
Last Name:LASTER
Suffix:
Gender:F
Credentials:CFO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 STATESVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2312
Mailing Address - Country:US
Mailing Address - Phone:704-637-0151
Mailing Address - Fax:704-637-0437
Practice Address - Street 1:126 STATESVILLE BLVD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2312
Practice Address - Country:US
Practice Address - Phone:704-637-0151
Practice Address - Fax:704-637-0437
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCFO03036225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter