Provider Demographics
NPI:1851447171
Name:DUNHAM, BONNE JANE (LM , RN, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:BONNE
Middle Name:JANE
Last Name:DUNHAM
Suffix:
Gender:F
Credentials:LM , RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-3110
Mailing Address - Country:US
Mailing Address - Phone:802-498-4247
Mailing Address - Fax:
Practice Address - Street 1:91 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-3110
Practice Address - Country:US
Practice Address - Phone:802-498-4247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT107-0000035176B00000X
VTL-110598163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1012847Medicaid