Provider Demographics
NPI:1104102672
Name:KREUTTER, BONNIE
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:
Last Name:KREUTTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 PAUL RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-4724
Mailing Address - Country:US
Mailing Address - Phone:585-247-2149
Mailing Address - Fax:585-340-5571
Practice Address - Street 1:571 PAUL RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-4724
Practice Address - Country:US
Practice Address - Phone:585-247-2149
Practice Address - Fax:585-340-5571
Is Sole Proprietor?:No
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311710-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool