Provider Demographics
NPI:1922310218
Name:BENDALL, BONNIE L (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:L
Last Name:BENDALL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:C
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:13150 HIGHWAY 43 STE 10
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35653-4566
Mailing Address - Country:US
Mailing Address - Phone:256-331-2092
Mailing Address - Fax:256-331-2096
Practice Address - Street 1:13150 HIGHWAY 43 STE 10
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653-4566
Practice Address - Country:US
Practice Address - Phone:256-331-2092
Practice Address - Fax:256-331-2096
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1107757363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102I500697Medicare UPIN