Provider Demographics
NPI:1124342928
Name:IKERD MANDELL, BONNIE (RN)
Entity type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:
Last Name:IKERD MANDELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:BONNIE
Other - Middle Name:
Other - Last Name:DEL POZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:9246 NORTHCOTE RD
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-4709
Mailing Address - Country:US
Mailing Address - Phone:619-861-3581
Mailing Address - Fax:
Practice Address - Street 1:9246 NORTHCOTE RD
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-4709
Practice Address - Country:US
Practice Address - Phone:619-861-3581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA683876163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse