Provider Demographics
NPI:1528209608
Name:BERRY, BONNADETTE LYNN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:BONNADETTE
Middle Name:LYNN
Last Name:BERRY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:LYNN
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:7275 TOWNSHIP ROAD 72
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:OH
Mailing Address - Zip Code:43320-9730
Mailing Address - Country:US
Mailing Address - Phone:419-688-9566
Mailing Address - Fax:
Practice Address - Street 1:7275 TOWNSHIP ROAD 72
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:OH
Practice Address - Zip Code:43320-9730
Practice Address - Country:US
Practice Address - Phone:419-688-9566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN081674164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse