Provider Demographics
NPI:1477711265
Name:CRUSE, BONNIE ANN (LPN)
Entity type:Individual
Prefix:MR
First Name:BONNIE
Middle Name:ANN
Last Name:CRUSE
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 1:1558 ENGLAND HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-8656
Mailing Address - Country:US
Mailing Address - Phone:740-773-2406
Mailing Address - Fax:
Practice Address - Street 1:1558 ENGLAND HOLLOW RD
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-8656
Practice Address - Country:US
Practice Address - Phone:740-773-2406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN115813164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse