Provider Demographics
NPI:1710245550
Name:CAMP, BONNIE (RN)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:CAMP
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 W SQUIRE DR
Mailing Address - Street 2:APT. 8
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-1723
Mailing Address - Country:US
Mailing Address - Phone:585-202-0008
Mailing Address - Fax:
Practice Address - Street 1:189 W SQUIRE DR
Practice Address - Street 2:APT. 8
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-1723
Practice Address - Country:US
Practice Address - Phone:585-202-0008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY632075163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse