Provider Demographics
NPI:1467736355
Name:MORALES, BONNIE SUE (FNP, RN)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:SUE
Last Name:MORALES
Suffix:
Gender:F
Credentials:FNP, RN
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:SUE
Other - Last Name:POYTRESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP, RN
Mailing Address - Street 1:126 N ELECTRIC AVE APT K
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-1927
Mailing Address - Country:US
Mailing Address - Phone:949-293-3169
Mailing Address - Fax:
Practice Address - Street 1:126 N ELECTRIC AVE APT K
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-1927
Practice Address - Country:US
Practice Address - Phone:949-293-3169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA737631163WP0200X
CA20329363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily