Provider Demographics
NPI:1437739281
Name:BONISLAWSI, MICHAEL FRANCIS (RN)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:FRANCIS
Last Name:BONISLAWSI
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 PINE TREE LN
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:PA
Mailing Address - Zip Code:17744-8024
Mailing Address - Country:US
Mailing Address - Phone:570-220-6299
Mailing Address - Fax:
Practice Address - Street 1:731 SALADA DR
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-8846
Practice Address - Country:US
Practice Address - Phone:570-220-6299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN506438L163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion TherapyGroup - Single Specialty