Provider Demographics
NPI:1720118896
Name:HASCALL, BONNIE JUNE (LVN)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:JUNE
Last Name:HASCALL
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2580 S MCCALL AVE
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:CA
Mailing Address - Zip Code:93657-9720
Mailing Address - Country:US
Mailing Address - Phone:559-264-7015
Mailing Address - Fax:
Practice Address - Street 1:594 W MUNCIE AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93619-8350
Practice Address - Country:US
Practice Address - Phone:559-325-1801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALVN91919164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA164X00000XMedicaid