Provider Demographics
NPI:1801145552
Name:ACKLES, BONNIE J (RN)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:J
Last Name:ACKLES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 PARADISE LN
Mailing Address - Street 2:SUITE #102
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-4686
Mailing Address - Country:US
Mailing Address - Phone:425-787-8699
Mailing Address - Fax:425-787-8699
Practice Address - Street 1:500 PARADISE LN
Practice Address - Street 2:SUITE #102
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-4686
Practice Address - Country:US
Practice Address - Phone:425-787-8699
Practice Address - Fax:425-787-8699
Is Sole Proprietor?:No
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN0004471163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management