Provider Demographics
NPI:1689197840
Name:BONNEVILLE, CAITLIN MARIE (RN, BSN)
Entity Type:Individual
Prefix:MS
First Name:CAITLIN
Middle Name:MARIE
Last Name:BONNEVILLE
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 RAWSON ST
Mailing Address - Street 2:
Mailing Address - City:LEICESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01524-2018
Mailing Address - Country:US
Mailing Address - Phone:774-287-1874
Mailing Address - Fax:
Practice Address - Street 1:184 RAWSON ST
Practice Address - Street 2:
Practice Address - City:LEICESTER
Practice Address - State:MA
Practice Address - Zip Code:01524-2018
Practice Address - Country:US
Practice Address - Phone:774-287-1874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2305696163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse