Provider Demographics
NPI:1609198829
Name:BEVERSTOCK, BONNIE (RN)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:BEVERSTOCK
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 1:200 DIVISION ST STE K
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-1843
Mailing Address - Country:US
Mailing Address - Phone:715-345-2929
Mailing Address - Fax:715-345-2870
Practice Address - Street 1:200 DIVISION ST STE K
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-1843
Practice Address - Country:US
Practice Address - Phone:715-345-2929
Practice Address - Fax:715-345-2870
Is Sole Proprietor?:No
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI106369 - 030163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory