Provider Demographics
NPI:1881916799
Name:BONNER, SHAUNTA LAFAYE (LVN)
Entity type:Individual
Prefix:MRS
First Name:SHAUNTA
Middle Name:LAFAYE
Last Name:BONNER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15506 HOLLOW CYPRESS CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77049-2526
Mailing Address - Country:US
Mailing Address - Phone:713-775-0254
Mailing Address - Fax:
Practice Address - Street 1:15506 HOLLOW CYPRESS CT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77049-2526
Practice Address - Country:US
Practice Address - Phone:713-775-0254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-18
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator