Provider Demographics
NPI:1952117418
Name:WILLIAMS, BONNIE (LPN)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 SPEED AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-4333
Mailing Address - Country:US
Mailing Address - Phone:318-355-1779
Mailing Address - Fax:318-582-5220
Practice Address - Street 1:PO BOX 2571
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71207-2571
Practice Address - Country:US
Practice Address - Phone:318-582-5069
Practice Address - Fax:318-582-5220
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALPN240367164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse