Provider Demographics
NPI:1346853652
Name:BONVENTRE, SUZANNE LESLIE (RN)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:LESLIE
Last Name:BONVENTRE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22670 HAGGERTY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-2631
Mailing Address - Country:US
Mailing Address - Phone:248-465-7370
Mailing Address - Fax:248-465-7303
Practice Address - Street 1:22670 HAGGERTY RD STE 100
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-2631
Practice Address - Country:US
Practice Address - Phone:248-465-7370
Practice Address - Fax:248-465-7303
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704164570163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse