Provider Demographics
NPI:1649868746
Name:BONVIE-HART, ELLEN (RN)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:BONVIE-HART
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 1:266 LANDING LN
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29909-6091
Mailing Address - Country:US
Mailing Address - Phone:617-480-8624
Mailing Address - Fax:
Practice Address - Street 1:266 LANDING LN
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29909-6091
Practice Address - Country:US
Practice Address - Phone:617-480-8624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC63415163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC63415OtherRN LICENSE