Provider Demographics
NPI:1457567679
Name:LANKFORD, BONNIE RAE (RMT)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:RAE
Last Name:LANKFORD
Suffix:
Gender:F
Credentials:RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 2ND AVE W
Mailing Address - Street 2:BOX 87
Mailing Address - City:DODSON
Mailing Address - State:MT
Mailing Address - Zip Code:59524
Mailing Address - Country:US
Mailing Address - Phone:406-383-4339
Mailing Address - Fax:
Practice Address - Street 1:345 GROS VENTRE AVE
Practice Address - Street 2:
Practice Address - City:HARLEM
Practice Address - State:MT
Practice Address - Zip Code:59526
Practice Address - Country:US
Practice Address - Phone:406-353-3100
Practice Address - Fax:406-353-3229
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT584246RM2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT76037OtherAMT LICENSE
MT584OtherLICENSE