Provider Demographics
NPI:1922390939
Name:MULLINS, BONNIE LYNETTE
Entity Type:Individual
Prefix:MR
First Name:BONNIE
Middle Name:LYNETTE
Last Name:MULLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:BONNIE
Other - Middle Name:LYNETTE
Other - Last Name:JOOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:843 E KAY ST
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-2242
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:843 E KAY ST
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550-2242
Practice Address - Country:US
Practice Address - Phone:309-265-5432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist