Provider Demographics
NPI:1689767006
Name:ROBERTSON, BONITA LYNNE
Entity Type:Individual
Prefix:MS
First Name:BONITA
Middle Name:LYNNE
Last Name:ROBERTSON
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 1:2595 W COUNTY ROAD 300 N
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47220-9764
Mailing Address - Country:US
Mailing Address - Phone:812-358-5851
Mailing Address - Fax:812-358-5851
Practice Address - Street 1:2595 W COUNTY ROAD 300 N
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN
Practice Address - State:IN
Practice Address - Zip Code:47220-9764
Practice Address - Country:US
Practice Address - Phone:812-358-5851
Practice Address - Fax:812-358-5851
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered376J00000XNursing Service Related ProvidersHomemaker
Not Answered376K00000XNursing Service Related ProvidersNurse's Aide