Provider Demographics
NPI:1811542830
Name:BONTON, TRENISHA
Entity Type:Individual
Prefix:
First Name:TRENISHA
Middle Name:
Last Name:BONTON
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 1:1040 BARRINGTON DR APT B
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:LA
Mailing Address - Zip Code:70714-7955
Mailing Address - Country:US
Mailing Address - Phone:225-502-6583
Mailing Address - Fax:
Practice Address - Street 1:9626 AIRLINE HWY STE 202
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-5564
Practice Address - Country:US
Practice Address - Phone:225-502-6583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management