Provider Demographics
NPI:1699405316
Name:BONNETT, REBECCA DIANE
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:DIANE
Last Name:BONNETT
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 1:871 MOUNT CLARE RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-7443
Mailing Address - Country:US
Mailing Address - Phone:304-695-3886
Mailing Address - Fax:
Practice Address - Street 1:871 MOUNT CLARE RD
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-7443
Practice Address - Country:US
Practice Address - Phone:304-695-3886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant