Provider Demographics
NPI:1063245272
Name:LANDSPURG, BONNIE (RN)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:LANDSPURG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 N HUNT DR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-6533
Mailing Address - Country:US
Mailing Address - Phone:480-472-7503
Mailing Address - Fax:
Practice Address - Street 1:630 N HUNT DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-6533
Practice Address - Country:US
Practice Address - Phone:480-472-7503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN173208163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse