Provider Demographics
NPI:1952815185
Name:MCCLUNG, BONITA RAE (PCA)
Entity Type:Individual
Prefix:MRS
First Name:BONITA
Middle Name:RAE
Last Name:MCCLUNG
Suffix:
Gender:F
Credentials:PCA
Other - Prefix:MS
Other - First Name:BONITA
Other - Middle Name:RAE
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:324 SETTLEMENT DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHARMCO
Mailing Address - State:WV
Mailing Address - Zip Code:25958
Mailing Address - Country:US
Mailing Address - Phone:304-438-5677
Mailing Address - Fax:
Practice Address - Street 1:324 SETTLEMENT DRIVE
Practice Address - Street 2:
Practice Address - City:CHARMCO
Practice Address - State:WV
Practice Address - Zip Code:25958
Practice Address - Country:US
Practice Address - Phone:304-438-5677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant