Provider Demographics
NPI:1942593728
Name:KRAFT, BONNIE G (RN)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:G
Last Name:KRAFT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 34A
Mailing Address - Street 2:
Mailing Address - City:WATONGA
Mailing Address - State:OK
Mailing Address - Zip Code:73772-9706
Mailing Address - Country:US
Mailing Address - Phone:580-623-4991
Mailing Address - Fax:580-623-5490
Practice Address - Street 1:RR 1 BOX 34A
Practice Address - Street 2:
Practice Address - City:WATONGA
Practice Address - State:OK
Practice Address - Zip Code:73772-9706
Practice Address - Country:US
Practice Address - Phone:580-623-4991
Practice Address - Fax:580-623-5490
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR 00046197163WC1500X
OKR0046197261QP0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100231960GMedicaid