Provider Demographics
NPI:1407121577
Name:BOHON, BRIE FONDA (RN)
Entity Type:Individual
Prefix:
First Name:BRIE
Middle Name:FONDA
Last Name:BOHON
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 1:1330 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:MO
Mailing Address - Zip Code:65355-3431
Mailing Address - Country:US
Mailing Address - Phone:660-428-1280
Mailing Address - Fax:660-428-1283
Practice Address - Street 1:1330 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:MO
Practice Address - Zip Code:65355-3431
Practice Address - Country:US
Practice Address - Phone:660-428-1280
Practice Address - Fax:660-428-1283
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO149469163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health