Provider Demographics
NPI:1467029470
Name:BONVILLE, KIZZY MICHELLE
Entity Type:Individual
Prefix:
First Name:KIZZY
Middle Name:MICHELLE
Last Name:BONVILLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 JENEVA LN
Mailing Address - Street 2:
Mailing Address - City:HARRINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19952-6429
Mailing Address - Country:US
Mailing Address - Phone:302-670-6739
Mailing Address - Fax:
Practice Address - Street 1:19 JENEVA LN
Practice Address - Street 2:
Practice Address - City:HARRINGTON
Practice Address - State:DE
Practice Address - Zip Code:19952-6429
Practice Address - Country:US
Practice Address - Phone:302-670-6739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DENA000000702334376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide