Provider Demographics
NPI:1750931564
Name:TEAL, BONIE
Entity type:Individual
Prefix:
First Name:BONIE
Middle Name:
Last Name:TEAL
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 1:24 WATERS EDGE RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27537
Mailing Address - Country:US
Mailing Address - Phone:540-293-7629
Mailing Address - Fax:
Practice Address - Street 1:24 WATERS EDGE RD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27537
Practice Address - Country:US
Practice Address - Phone:540-293-7629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider