Provider Demographics
NPI:1669070447
Name:NEVLAND, BONNIE H
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:H
Last Name:NEVLAND
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:PO BOX 342
Mailing Address - Street 2:
Mailing Address - City:WESTHOPE
Mailing Address - State:ND
Mailing Address - Zip Code:58793-0342
Mailing Address - Country:US
Mailing Address - Phone:701-833-7279
Mailing Address - Fax:
Practice Address - Street 1:195 1ST ST W
Practice Address - Street 2:
Practice Address - City:WESTHOPE
Practice Address - State:ND
Practice Address - Zip Code:58793-4042
Practice Address - Country:US
Practice Address - Phone:701-245-6207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1476539376J00000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker