Provider Demographics
NPI:1407444854
Name:SEDLACEK, BONNIE KAY (RN)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:KAY
Last Name:SEDLACEK
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 1:401 S 1ST ST UNIT 809
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55401-2565
Mailing Address - Country:US
Mailing Address - Phone:612-940-0573
Mailing Address - Fax:
Practice Address - Street 1:3655 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55418-1342
Practice Address - Country:US
Practice Address - Phone:612-789-2460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1073793163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine