Provider Demographics
NPI:1366921330
Name:TURNER, BONNIE (LVN)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:TURNER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 MEMORIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78374-2447
Mailing Address - Country:US
Mailing Address - Phone:830-900-9666
Mailing Address - Fax:
Practice Address - Street 1:1613 MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TX
Practice Address - Zip Code:78374-2447
Practice Address - Country:US
Practice Address - Phone:830-900-9666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112454164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty