Provider Demographics
NPI:1932932738
Name:BONNER, ERAINA ALLYSSE
Entity type:Individual
Prefix:MS
First Name:ERAINA
Middle Name:ALLYSSE
Last Name:BONNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9326 WARWICK
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-1735
Mailing Address - Country:US
Mailing Address - Phone:313-307-2514
Mailing Address - Fax:
Practice Address - Street 1:12047 SUSSEX
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-2073
Practice Address - Country:US
Practice Address - Phone:313-307-2514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372600000XNursing Service Related ProvidersAdult Companion
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7310232Medicaid