Provider Demographics
NPI:1699000380
Name:DYE, BONNIE REBECCA
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:REBECCA
Last Name:DYE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:REBECCA
Other - Last Name:BUZZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:437 PLYMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:BUCYRUS
Mailing Address - State:OH
Mailing Address - Zip Code:44820-1634
Mailing Address - Country:US
Mailing Address - Phone:419-563-4060
Mailing Address - Fax:
Practice Address - Street 1:437 PLYMOUTH ST
Practice Address - Street 2:
Practice Address - City:BUCYRUS
Practice Address - State:OH
Practice Address - Zip Code:44820-1634
Practice Address - Country:US
Practice Address - Phone:419-563-4060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-13
Last Update Date:2012-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN122374-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRN37344OtherOHIO BOARD OF NURSING