Provider Demographics
NPI:1609673813
Name:PHILLIPS, BONNIE
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-3258
Mailing Address - Country:US
Mailing Address - Phone:402-452-7902
Mailing Address - Fax:
Practice Address - Street 1:2001 VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-3258
Practice Address - Country:US
Practice Address - Phone:402-452-7902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant