Provider Demographics
NPI:1487805867
Name:BONNER, SHAWANA NECO (LPN)
Entity type:Individual
Prefix:
First Name:SHAWANA
Middle Name:NECO
Last Name:BONNER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4531 ELMER ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-1336
Mailing Address - Country:US
Mailing Address - Phone:937-475-7292
Mailing Address - Fax:
Practice Address - Street 1:4531 ELMER ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-1336
Practice Address - Country:US
Practice Address - Phone:937-475-7292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 108108164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse