Provider Demographics
NPI:1851686513
Name:PICKERING, BONNIE MAE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:MAE
Last Name:PICKERING
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3986 STATE RT 37
Mailing Address - Street 2:
Mailing Address - City:CONSTABLE
Mailing Address - State:NY
Mailing Address - Zip Code:12926-1918
Mailing Address - Country:US
Mailing Address - Phone:518-358-3394
Mailing Address - Fax:
Practice Address - Street 1:3986 STATE RT 37
Practice Address - Street 2:
Practice Address - City:CONSTABLE
Practice Address - State:NY
Practice Address - Zip Code:12926-1918
Practice Address - Country:US
Practice Address - Phone:518-358-3394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY289541164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse