Provider Demographics
NPI:1811250079
Name:CARTER, BONNIE L
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:L
Last Name:CARTER
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 1:95 FRANKLIN ST
Mailing Address - Street 2:RM 828
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-3925
Mailing Address - Country:US
Mailing Address - Phone:716-858-2133
Mailing Address - Fax:716-858-6892
Practice Address - Street 1:95 FRANKLIN ST
Practice Address - Street 2:RM 828
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-3925
Practice Address - Country:US
Practice Address - Phone:716-858-2133
Practice Address - Fax:716-858-6892
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator