Provider Demographics
NPI:1134539687
Name:SPURLOCK, BONNIE (LPN)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:SPURLOCK
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 1:461 TUSCANY VALLEY CT APT 2
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-5490
Mailing Address - Country:US
Mailing Address - Phone:513-746-1662
Mailing Address - Fax:
Practice Address - Street 1:461 TUSCANY VALLEY CT APT 2
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-5490
Practice Address - Country:US
Practice Address - Phone:513-746-1662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 125504164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse