Provider Demographics
NPI:1427298686
Name:MOTTER, BONNIE (RN)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:MOTTER
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:PO BOX 5077
Mailing Address - Street 2:
Mailing Address - City:PAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:86040-5077
Mailing Address - Country:US
Mailing Address - Phone:928-353-2284
Mailing Address - Fax:
Practice Address - Street 1:HIGHWAY 98 ROUTE 16
Practice Address - Street 2:
Practice Address - City:TONALEA
Practice Address - State:AZ
Practice Address - Zip Code:86044
Practice Address - Country:US
Practice Address - Phone:928-672-3087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN086273163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse