Provider Demographics
NPI:1609381920
Name:MARENGER, BONNIE (LPN)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:MARENGER
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 1:7260 L RD
Mailing Address - Street 2:
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-9545
Mailing Address - Country:US
Mailing Address - Phone:906-786-9476
Mailing Address - Fax:
Practice Address - Street 1:1019 N 16TH ST
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-1541
Practice Address - Country:US
Practice Address - Phone:906-233-9794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703055775164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse