Provider Demographics
NPI:1538663380
Name:BURWELL, BONESHA
Entity Type:Individual
Prefix:
First Name:BONESHA
Middle Name:
Last Name:BURWELL
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 1:403 STOCKTON ST APT 4156
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224-4351
Mailing Address - Country:US
Mailing Address - Phone:804-908-0091
Mailing Address - Fax:
Practice Address - Street 1:403 STOCKTON ST APT 4156
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23224-4351
Practice Address - Country:US
Practice Address - Phone:804-908-0091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT28432454347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle