Provider Demographics
NPI:1801163050
Name:MATACALE, BONNIE JEAN (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:JEAN
Last Name:MATACALE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 ELLAS AVE
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:NY
Mailing Address - Zip Code:14810-1107
Mailing Address - Country:US
Mailing Address - Phone:607-776-4110
Mailing Address - Fax:607-776-6873
Practice Address - Street 1:25 ELLAS AVE
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-1107
Practice Address - Country:US
Practice Address - Phone:607-776-4110
Practice Address - Fax:607-776-6873
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195588-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool