Provider Demographics
NPI:1285931899
Name:GRABLE, BONITA JEAN
Entity type:Individual
Prefix:MRS
First Name:BONITA
Middle Name:JEAN
Last Name:GRABLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 W PAGENTRY DRIVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-2304
Mailing Address - Country:US
Mailing Address - Phone:702-642-2697
Mailing Address - Fax:
Practice Address - Street 1:1201 PAGENTRY DR
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-2304
Practice Address - Country:US
Practice Address - Phone:702-642-2697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner