Provider Demographics
NPI:1649001272
Name:POWERS, BONNIE LEE (RN)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:LEE
Last Name:POWERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:BONNITA
Other - Middle Name:LEE
Other - Last Name:POWERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7219 W SWIFT LN
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-5961
Mailing Address - Country:US
Mailing Address - Phone:208-412-4612
Mailing Address - Fax:
Practice Address - Street 1:960 S BROADWAY AVE STE 505
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-3630
Practice Address - Country:US
Practice Address - Phone:208-780-6255
Practice Address - Fax:208-780-6291
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN-39504163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management