Provider Demographics
NPI:1790360238
Name:ONEIL, BONITA
Entity Type:Individual
Prefix:
First Name:BONITA
Middle Name:
Last Name:ONEIL
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 1:9537 MIDDLE GRAVE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:GLEN EASTON
Mailing Address - State:WV
Mailing Address - Zip Code:26039-1486
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9537 MIDDLE GRAVE CREEK RD
Practice Address - Street 2:
Practice Address - City:GLEN EASTON
Practice Address - State:WV
Practice Address - Zip Code:26039-1486
Practice Address - Country:US
Practice Address - Phone:304-845-1850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker