Provider Demographics
NPI:1598045692
Name:PEOT, BONNIE KAY (LPN)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:KAY
Last Name:PEOT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:BONNIE
Other - Middle Name:KAY
Other - Last Name:GOTTSCHELK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:1420 WEDGEWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53098
Mailing Address - Country:US
Mailing Address - Phone:920-261-6234
Mailing Address - Fax:
Practice Address - Street 1:1420 WEDGEWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53098
Practice Address - Country:US
Practice Address - Phone:920-261-6234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23951-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse