Provider Demographics
NPI:1568286979
Name:ELLIOTT, BONNIE ELAINE (STNA)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:ELAINE
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1159 MARYLAND ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:OH
Mailing Address - Zip Code:45101-9749
Mailing Address - Country:US
Mailing Address - Phone:937-779-6314
Mailing Address - Fax:
Practice Address - Street 1:1159 MARYLAND ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:OH
Practice Address - Zip Code:45101-9749
Practice Address - Country:US
Practice Address - Phone:937-779-6314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRMO836003747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant