Provider Demographics
NPI:1710219647
Name:SPRINKLE, BONNIE L
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:L
Last Name:SPRINKLE
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:PO BOX 138
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:NY
Mailing Address - Zip Code:12928-0138
Mailing Address - Country:US
Mailing Address - Phone:518-597-3313
Mailing Address - Fax:
Practice Address - Street 1:2040 CREEK ROAD
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:NY
Practice Address - Zip Code:12928
Practice Address - Country:US
Practice Address - Phone:518-597-3313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20-8418730225500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist