Provider Demographics
NPI:1104969070
Name:JEANICE, BONNIE JEAN (COMMUNITY HEALTH NUR)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:JEAN
Last Name:JEANICE
Suffix:
Gender:F
Credentials:COMMUNITY HEALTH NUR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 442 BOX 839
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09042
Mailing Address - Country:DE
Mailing Address - Phone:621-718-7761
Mailing Address - Fax:
Practice Address - Street 1:CMR 442 BOX 839
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09042
Practice Address - Country:DE
Practice Address - Phone:621-718-7761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC148779163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health