Provider Demographics
NPI:1386849099
Name:MAGGY, BONNIE L (ILST)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:L
Last Name:MAGGY
Suffix:
Gender:F
Credentials:ILST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4517 MILITARY TPKE
Mailing Address - Street 2:
Mailing Address - City:ALTONA
Mailing Address - State:NY
Mailing Address - Zip Code:12910-2718
Mailing Address - Country:US
Mailing Address - Phone:518-493-5437
Mailing Address - Fax:
Practice Address - Street 1:4517 MILITARY TPKE
Practice Address - Street 2:
Practice Address - City:ALTONA
Practice Address - State:NY
Practice Address - Zip Code:12910-2718
Practice Address - Country:US
Practice Address - Phone:518-493-5437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist