Provider Demographics
NPI:1386826576
Name:BONNER, SHARON SUSIE (RN)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:SUSIE
Last Name:BONNER
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 1:28475 GREENFIELD RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-3034
Mailing Address - Country:US
Mailing Address - Phone:248-395-8501
Mailing Address - Fax:248-281-1677
Practice Address - Street 1:28475 GREENFIELD RD
Practice Address - Street 2:SUITE 109
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-3034
Practice Address - Country:US
Practice Address - Phone:248-395-8501
Practice Address - Fax:248-281-1677
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health