Provider Demographics
NPI:1407067036
Name:BONVENTRE, JOYCE A (RN)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:A
Last Name:BONVENTRE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JOYCE
Other - Middle Name:
Other - Last Name:SWANTNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2333 BIDDLE ST
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-4668
Mailing Address - Country:US
Mailing Address - Phone:734-246-9597
Mailing Address - Fax:734-246-6990
Practice Address - Street 1:2333 BIDDLE ST
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-4668
Practice Address - Country:US
Practice Address - Phone:734-246-9597
Practice Address - Fax:734-246-6990
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704158474163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704158474OtherSTATE LICENSE