Provider Demographics
NPI:1740837277
Name:WIPF, BONNIE LEE (LPN)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:LEE
Last Name:WIPF
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8513 STABLES DRIVE
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:SD
Mailing Address - Zip Code:57769
Mailing Address - Country:US
Mailing Address - Phone:605-787-9378
Mailing Address - Fax:
Practice Address - Street 1:8513 STABLES DR.
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:SD
Practice Address - Zip Code:57769
Practice Address - Country:US
Practice Address - Phone:605-787-9378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider