Provider Demographics
NPI:1790568483
Name:STRICKLAND, BONNIE ROBIN
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:ROBIN
Last Name:STRICKLAND
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 1:184 HIMES RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45144-8306
Mailing Address - Country:US
Mailing Address - Phone:937-515-3740
Mailing Address - Fax:
Practice Address - Street 1:16485 EDGINGTON RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:OH
Practice Address - Zip Code:45176-6537
Practice Address - Country:US
Practice Address - Phone:937-515-3740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty