Provider Demographics
NPI:1174722656
Name:BAYER, BONITA VICTORIA (LPN)
Entity type:Individual
Prefix:MS
First Name:BONITA
Middle Name:VICTORIA
Last Name:BAYER
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 1:31 TONE TER
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-1215
Mailing Address - Country:US
Mailing Address - Phone:585-544-9189
Mailing Address - Fax:
Practice Address - Street 1:31 TONE TER
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14617-1215
Practice Address - Country:US
Practice Address - Phone:585-544-9189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058527-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02151059Medicaid