Provider Demographics
NPI:1558921437
Name:JAIME, BONITA FAITH (RN)
Entity Type:Individual
Prefix:
First Name:BONITA
Middle Name:FAITH
Last Name:JAIME
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11659 N LOOP DR
Mailing Address - Street 2:
Mailing Address - City:SOCORRO
Mailing Address - State:TX
Mailing Address - Zip Code:79927-4508
Mailing Address - Country:US
Mailing Address - Phone:915-216-8903
Mailing Address - Fax:
Practice Address - Street 1:11659 N LOOP DR
Practice Address - Street 2:
Practice Address - City:SOCORRO
Practice Address - State:TX
Practice Address - Zip Code:79927-4508
Practice Address - Country:US
Practice Address - Phone:915-216-8903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX962248163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse