Provider Demographics
NPI:1558786335
Name:BROWN, BONNIE (LVN)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MS
Other - First Name:BONNIE
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LVN
Mailing Address - Street 1:6643 VALLEY HI DR
Mailing Address - Street 2:#337
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-7017
Mailing Address - Country:US
Mailing Address - Phone:916-399-8267
Mailing Address - Fax:
Practice Address - Street 1:5 NIKKI CT
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-6758
Practice Address - Country:US
Practice Address - Phone:916-803-0458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA214031164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse