Provider Demographics
NPI:1104980150
Name:PARHAM, BONNIE J (LPN)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:J
Last Name:PARHAM
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 1:250 FOSTER KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:JOPPA
Mailing Address - State:MD
Mailing Address - Zip Code:21085-4704
Mailing Address - Country:US
Mailing Address - Phone:410-679-6647
Mailing Address - Fax:
Practice Address - Street 1:4110 AUSTIN ROAD
Practice Address - Street 2:
Practice Address - City:GUNPOWDER
Practice Address - State:MD
Practice Address - Zip Code:21010
Practice Address - Country:US
Practice Address - Phone:410-436-3001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP36500164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse