Provider Demographics
NPI:1669722559
Name:BONNEY, CATHY JO
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:JO
Last Name:BONNEY
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 1:130 SPRING AVE
Mailing Address - Street 2:
Mailing Address - City:FERGUSON
Mailing Address - State:MO
Mailing Address - Zip Code:63135-2345
Mailing Address - Country:US
Mailing Address - Phone:314-819-3071
Mailing Address - Fax:
Practice Address - Street 1:130 SPRING AVE
Practice Address - Street 2:
Practice Address - City:FERGUSON
Practice Address - State:MO
Practice Address - Zip Code:63135-2345
Practice Address - Country:US
Practice Address - Phone:314-819-3071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO001834564OtherDAY CARE