Provider Demographics
NPI:1700429016
Name:BONET, BEATRICE A
Entity Type:Individual
Prefix:
First Name:BEATRICE
Middle Name:A
Last Name:BONET
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 1:4 SKIFF ST APT B310
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-1834
Mailing Address - Country:US
Mailing Address - Phone:860-985-6905
Mailing Address - Fax:
Practice Address - Street 1:280 QUARRY RD UNIT C
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-8543
Practice Address - Country:US
Practice Address - Phone:203-772-9725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTNA9994760374U00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTNA9994760OtherCERTIFIED NURSING AIDE