Provider Demographics
NPI:1881818565
Name:KIERNAN, BONNIE C (REGISTERED NURSE)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:C
Last Name:KIERNAN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:MEDWAY
Mailing Address - State:MA
Mailing Address - Zip Code:02053-2429
Mailing Address - Country:US
Mailing Address - Phone:508-533-1956
Mailing Address - Fax:
Practice Address - Street 1:10 ALDEN ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-1002
Practice Address - Country:US
Practice Address - Phone:508-863-1089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA152179163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0799149OtherINDEPENDENT NURSEPROVIDER