Provider Demographics
NPI:1497951511
Name:BONO-JOHNSON, TRACY KATHERINE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:KATHERINE
Last Name:BONO-JOHNSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:TRACY
Other - Middle Name:KATHERINE
Other - Last Name:BONO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:550 POPE AVE
Mailing Address - Street 2:MUNSON ARMY HEALTH CENTER ATTN MCXN-COD MS. COTTON
Mailing Address - City:FORT LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66027-2332
Mailing Address - Country:US
Mailing Address - Phone:913-684-6562
Mailing Address - Fax:913-684-6208
Practice Address - Street 1:550 POPE AVE
Practice Address - Street 2:MUNSON ARMY HEALTH CENTER ATTN MCXN-COD MS. COTTON
Practice Address - City:FORT LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66027-2332
Practice Address - Country:US
Practice Address - Phone:913-684-6562
Practice Address - Fax:913-684-6208
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006021076164W00000X
KS24-35850-062164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2006021076OtherLPN IV CERTIFIED
KS24-35850-062OtherLPN IV CERTIFIED