Provider Demographics
NPI:1962424119
Name:CORRIGAN, BONNIE B (RN)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:B
Last Name:CORRIGAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:
Other - Last Name:BOHACEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4245 PINTO LN
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-9624
Mailing Address - Country:US
Mailing Address - Phone:843-903-5607
Mailing Address - Fax:
Practice Address - Street 1:164 WACCAMAW MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-8903
Practice Address - Country:US
Practice Address - Phone:843-347-5060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37698163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health