Provider Demographics
NPI:1316429533
Name:CABRERA, BONNIE SUE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:SUE
Last Name:CABRERA
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:S
Other - Last Name:HAATAJA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:216 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:HATLEY
Mailing Address - State:WI
Mailing Address - Zip Code:54440
Mailing Address - Country:US
Mailing Address - Phone:715-803-8086
Mailing Address - Fax:
Practice Address - Street 1:216 CLARK ST
Practice Address - Street 2:
Practice Address - City:HATLEY
Practice Address - State:WI
Practice Address - Zip Code:54440
Practice Address - Country:US
Practice Address - Phone:715-803-8086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI233541-30163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health