Individual
MRS. BONNIE JEAN TIBBITTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
4901 N CLAIREMONT AVE, EAU CLAIRE, WI 54703-3869
(715) 874-5489
Mailing address
1405 TRUAX BLVD, EAU CLAIRE, WI 54703-1474
(715) 552-1030
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
1537026
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42058800
—
WI
Enumeration date
05/10/2008
Last updated
05/10/2008
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