Provider Demographics
NPI:1306165444
Name:BONNER, ROSE (RN)
Entity type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:
Last Name:BONNER
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 1:4309 MISSION CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-3353
Mailing Address - Country:US
Mailing Address - Phone:702-324-3271
Mailing Address - Fax:703-322-1518
Practice Address - Street 1:12011 GOVERNMENT CENTER PKWY STE 300
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22035-1100
Practice Address - Country:US
Practice Address - Phone:703-324-3271
Practice Address - Fax:703-322-1518
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001078473163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management