Provider Demographics
NPI:1477168904
Name:ROBINSON, BONNIE LEE
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:LEE
Last Name:ROBINSON
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 1:26 SPRINGFIELD PIKE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:26763
Mailing Address - Country:US
Mailing Address - Phone:304-359-3149
Mailing Address - Fax:
Practice Address - Street 1:26 SPRINGFIELD PIKE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:WV
Practice Address - Zip Code:26763
Practice Address - Country:US
Practice Address - Phone:304-359-3149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant