Provider Demographics
NPI:1568043016
Name:OHARA, BONNIE
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:OHARA
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 1:51475 SR 145
Mailing Address - Street 2:
Mailing Address - City:JERUSALEM
Mailing Address - State:WV
Mailing Address - Zip Code:43747
Mailing Address - Country:US
Mailing Address - Phone:740-213-1486
Mailing Address - Fax:
Practice Address - Street 1:51475 SR 145
Practice Address - Street 2:
Practice Address - City:JERUSALEM
Practice Address - State:WV
Practice Address - Zip Code:43747
Practice Address - Country:US
Practice Address - Phone:740-213-1486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker