Provider Demographics
NPI:1699374983
Name:JOSEPH, BONNIE J
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:J
Last Name:JOSEPH
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 1:43199 STATE ROUTE 517
Mailing Address - Street 2:
Mailing Address - City:COLUMBIANA
Mailing Address - State:OH
Mailing Address - Zip Code:44408-9532
Mailing Address - Country:US
Mailing Address - Phone:330-227-9083
Mailing Address - Fax:
Practice Address - Street 1:43199 STATE ROUTE 517
Practice Address - Street 2:
Practice Address - City:COLUMBIANA
Practice Address - State:OH
Practice Address - Zip Code:44408-9532
Practice Address - Country:US
Practice Address - Phone:330-227-9083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0354433Medicaid
OHT-1019Medicaid