Provider Demographics
NPI:1548597008
Name:ENGEN, BONNIE RAE (RN/PHN)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:RAE
Last Name:ENGEN
Suffix:
Gender:F
Credentials:RN/PHN
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:RAE
Other - Last Name:DAHLKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:212 MAIN AVE N
Mailing Address - Street 2:
Mailing Address - City:BAGLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56621-8313
Mailing Address - Country:US
Mailing Address - Phone:218-694-6581
Mailing Address - Fax:
Practice Address - Street 1:212 MAIN AVE N
Practice Address - Street 2:
Practice Address - City:BAGLEY
Practice Address - State:MN
Practice Address - Zip Code:56621-8313
Practice Address - Country:US
Practice Address - Phone:218-694-6581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR84658-1163W00000X, 163WA2000X, 163WC0400X
MN5540163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health