Provider Demographics
NPI:1356767354
Name:BONNELL, GWEN
Entity type:Individual
Prefix:
First Name:GWEN
Middle Name:
Last Name:BONNELL
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 1:601 WILMINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-4956
Mailing Address - Country:US
Mailing Address - Phone:843-525-5031
Mailing Address - Fax:843-770-2075
Practice Address - Street 1:601 WILMINGTON ST
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-4956
Practice Address - Country:US
Practice Address - Phone:843-525-5031
Practice Address - Fax:843-770-2075
Is Sole Proprietor?:No
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC92676163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health