Provider Demographics
NPI:1922401090
Name:WALKER, BONNIE LEE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:LEE
Last Name:WALKER
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 1:4 W DAYTON YELLOW SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-3435
Mailing Address - Country:US
Mailing Address - Phone:937-879-8198
Mailing Address - Fax:937-879-8196
Practice Address - Street 1:4 W DAYTON YELLOW SPRINGS RD
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-3435
Practice Address - Country:US
Practice Address - Phone:937-879-8198
Practice Address - Fax:937-879-8196
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN114613-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse