Provider Demographics
NPI:1205448206
Name:CUMMINS, BONITA A (RN)
Entity type:Individual
Prefix:
First Name:BONITA
Middle Name:A
Last Name:CUMMINS
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 1:9319 RASPBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKSTON
Mailing Address - State:TX
Mailing Address - Zip Code:75763-4309
Mailing Address - Country:US
Mailing Address - Phone:903-504-2894
Mailing Address - Fax:
Practice Address - Street 1:7922 S BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-5242
Practice Address - Country:US
Practice Address - Phone:903-245-6695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX849445163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator