Provider Demographics
NPI:1588016547
Name:WESTRA, BONNIE (RN, PHD)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:WESTRA
Suffix:
Gender:F
Credentials:RN, PHD
Other - Prefix:
Other - First Name:BONITA
Other - Middle Name:
Other - Last Name:WESTRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, PHD
Mailing Address - Street 1:308 HARVARD ST SE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0353
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:308 HARVARD ST SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0353
Practice Address - Country:US
Practice Address - Phone:612-625-4470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-01
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 079186-6163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse