Provider Demographics
NPI:1407357163
Name:DUNKELBERGER, BONITA JEAN (LMT)
Entity Type:Individual
Prefix:
First Name:BONITA
Middle Name:JEAN
Last Name:DUNKELBERGER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3006 AVENUE K
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-0781
Mailing Address - Country:US
Mailing Address - Phone:712-355-0596
Mailing Address - Fax:
Practice Address - Street 1:1219 LEAVENWORTH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-3214
Practice Address - Country:US
Practice Address - Phone:402-884-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3561225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist