Provider Demographics
NPI:1508040700
Name:BONLENDER, SARA MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:MARIE
Last Name:BONLENDER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1841 EDGEWOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:KEWASKUM
Mailing Address - State:WI
Mailing Address - Zip Code:53040
Mailing Address - Country:US
Mailing Address - Phone:262-626-4041
Mailing Address - Fax:
Practice Address - Street 1:1841 EDGEWOOD ROAD
Practice Address - Street 2:
Practice Address - City:KEWASKUM
Practice Address - State:WI
Practice Address - Zip Code:53040
Practice Address - Country:US
Practice Address - Phone:262-626-4041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse