Provider Demographics
NPI:1194482521
Name:HENSON, BONITA BROWN (RN)
Entity type:Individual
Prefix:
First Name:BONITA
Middle Name:BROWN
Last Name:HENSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SIX POINT CT
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2072
Mailing Address - Country:US
Mailing Address - Phone:410-724-2579
Mailing Address - Fax:
Practice Address - Street 1:15 SIX POINT CT
Practice Address - Street 2:
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-2072
Practice Address - Country:US
Practice Address - Phone:144-357-0837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR091566163WX0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-Risk