Provider Demographics
NPI:1760287544
Name:STENDAHL, BONNY IRENE
Entity type:Individual
Prefix:
First Name:BONNY
Middle Name:IRENE
Last Name:STENDAHL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:BONNY
Other - Middle Name:
Other - Last Name:BROSIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:115 1/2 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:KIMBALL
Mailing Address - State:NE
Mailing Address - Zip Code:69145-1200
Mailing Address - Country:US
Mailing Address - Phone:308-230-0754
Mailing Address - Fax:
Practice Address - Street 1:115 1/2 W 2ND ST
Practice Address - Street 2:
Practice Address - City:KIMBALL
Practice Address - State:NE
Practice Address - Zip Code:69145-1200
Practice Address - Country:US
Practice Address - Phone:308-230-0754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion