Provider Demographics
NPI:1265760227
Name:EUSTON, BONITA LYNN (RN)
Entity type:Individual
Prefix:MS
First Name:BONITA
Middle Name:LYNN
Last Name:EUSTON
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 1:24A MILTON AVE
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-1404
Mailing Address - Country:US
Mailing Address - Phone:518-885-7034
Mailing Address - Fax:
Practice Address - Street 1:24A MILTON AVE
Practice Address - Street 2:
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020-1404
Practice Address - Country:US
Practice Address - Phone:518-885-7034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-02
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203617-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse