Provider Demographics
NPI:1184954521
Name:BONNER, CYNTHIA RENEE (LPN)
Entity type:Individual
Prefix:MISS
First Name:CYNTHIA
Middle Name:RENEE
Last Name:BONNER
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 1:1855 MECHANICSBURG RD APT E3
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-2673
Mailing Address - Country:US
Mailing Address - Phone:330-412-3907
Mailing Address - Fax:
Practice Address - Street 1:1855 MECHANICSBURG RD APT E3
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-2673
Practice Address - Country:US
Practice Address - Phone:330-412-3907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-07
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH134081-IV164W00000X
OH134081164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse