Provider Demographics
NPI:1952887424
Name:BONNEVILLE, JENNIFER (LVN)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:BONNEVILLE
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 1:5327 BARONET DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-1496
Mailing Address - Country:US
Mailing Address - Phone:281-796-2632
Mailing Address - Fax:
Practice Address - Street 1:5327 BARONET DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-1496
Practice Address - Country:US
Practice Address - Phone:281-796-2632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX303152164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse