Provider Demographics
NPI:1366205288
Name:SOFIA, BONNIE MICHELLE (CHW)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:MICHELLE
Last Name:SOFIA
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 W KALAMAZOO AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-3347
Mailing Address - Country:US
Mailing Address - Phone:269-270-7242
Mailing Address - Fax:
Practice Address - Street 1:440 W KALAMAZOO AVE STE 102
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-3347
Practice Address - Country:US
Practice Address - Phone:269-270-7242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker