Provider Demographics
NPI:1558827196
Name:STEGALL, BONNIE MAY (LPN)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:MAY
Last Name:STEGALL
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:W3728 COUNTY ROAD P
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54491-9761
Mailing Address - Country:US
Mailing Address - Phone:715-216-4346
Mailing Address - Fax:
Practice Address - Street 1:W3728 COUNTY ROAD P
Practice Address - Street 2:
Practice Address - City:WHITE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54491-9761
Practice Address - Country:US
Practice Address - Phone:715-216-4346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI323099-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse