Provider Demographics
NPI:1124051222
Name:STITES, BONNIE LOU (ARDMS)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:LOU
Last Name:STITES
Suffix:
Gender:F
Credentials:ARDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 180B
Mailing Address - Street 2:
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-8901
Mailing Address - Country:US
Mailing Address - Phone:918-774-0004
Mailing Address - Fax:
Practice Address - Street 1:RR 2 BOX 180B
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-8901
Practice Address - Country:US
Practice Address - Phone:918-774-0004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1073902471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography