Individual
BONNIE BINGHAM I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
122 WILDWOOD CIR, HOLTSVILLE, NY 11742-1617
(631) 368-6464
Mailing address
122 WILDWOOD CIR, HOLTSVILLE, NY 11742-1617
(631) 368-6464
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
626519-1
NY
163WH0200X
Home Health Registered Nurse
Primary
626519-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
163W00000X
RN
NY
Enumeration date
12/08/2014
Last updated
12/08/2014
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