Provider Demographics
NPI:1871119644
Name:DURHAM, BONNIE ANN
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:ANN
Last Name:DURHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 LILIUM ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-2751
Mailing Address - Country:US
Mailing Address - Phone:775-461-6352
Mailing Address - Fax:
Practice Address - Street 1:259 LILIUM ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-2751
Practice Address - Country:US
Practice Address - Phone:503-871-4793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide