Provider Demographics
NPI:1417368861
Name:HARRIS, BONNIE JEAN (BSN, RN)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:JEAN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 5TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1521
Mailing Address - Country:US
Mailing Address - Phone:360-412-4773
Mailing Address - Fax:
Practice Address - Street 1:7600 5TH AVE SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1521
Practice Address - Country:US
Practice Address - Phone:360-412-4773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60302804163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool