Provider Demographics
NPI:1710947635
Name:FRUGE, BONNIE RUTH (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:RUTH
Last Name:FRUGE
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:RUTH
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CFNP
Mailing Address - Street 1:P O BOX 122108
Mailing Address - Street 2:DEPT 2108
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75312-2108
Mailing Address - Country:US
Mailing Address - Phone:337-480-8066
Mailing Address - Fax:337-480-8064
Practice Address - Street 1:1717 OAK PARK BLVD FL 3
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8990
Practice Address - Country:US
Practice Address - Phone:337-494-6865
Practice Address - Fax:337-494-6869
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN054410-AP03579363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1431869Medicaid
LA1431869Medicaid