Provider Demographics
NPI:1194193920
Name:BATICADOS, BONNAFE I (BSN, RN, WCC)
Entity type:Individual
Prefix:MRS
First Name:BONNAFE
Middle Name:I
Last Name:BATICADOS
Suffix:
Gender:F
Credentials:BSN, RN, WCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3241 JUSTAMERE RD
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-3759
Mailing Address - Country:US
Mailing Address - Phone:630-544-8517
Mailing Address - Fax:
Practice Address - Street 1:3241 JUSTAMERE RD
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-3759
Practice Address - Country:US
Practice Address - Phone:630-544-8517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.280969163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0000XNursing Service ProvidersRegistered NurseWound Care