Provider Demographics
NPI:1447450119
Name:BRATT, BONNIE LEE (RN)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:LEE
Last Name:BRATT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10966 SLAYTON RD
Mailing Address - Street 2:
Mailing Address - City:CATO
Mailing Address - State:NY
Mailing Address - Zip Code:13033-4220
Mailing Address - Country:US
Mailing Address - Phone:315-626-6010
Mailing Address - Fax:
Practice Address - Street 1:10966 SLAYTON RD
Practice Address - Street 2:
Practice Address - City:CATO
Practice Address - State:NY
Practice Address - Zip Code:13033-4220
Practice Address - Country:US
Practice Address - Phone:315-626-6010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208164-1163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02745504Medicaid