Individual
BONNY R. GILMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
667 EASTLAND AVE SE, WARREN, OH 44484
(330) 841-4100
(330) 286-5396
Mailing address
4135 BOARDMAN CANFIELD RD STE 101, CANFIELD, OH 44406-9803
(330) 286-5330
(330) 286-5396
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN186940
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0955980
MEDICAID
OH
01
—
H139250
MEDICARE PTAN
OH
01
—
P01188848
MEDICARE RAILROAD
OH
Enumeration date
05/15/2006
Last updated
12/26/2018
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