MEDICARE: BONNIE WEST R.N., B.S.N

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WS0200X	School Registered Nurse	R0072225	OK

General Provider Information

NPI Number	:	1538532346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONNIE WEST R.N., B.S.N

Provider Business Mailing Address
First Line	:	21560 SMITH RD
Second Line	:
City	:	MORRIS
State	:	OK
Zip	:	74445-2691
Country	:	US
Telephone Number	:	918-261-0328
Fax Number	:

Provider Business Practice Location Address
First Line	:	307 S 6TH ST
Second Line	:
City	:	MORRIS
State	:	OK
Zip	:	74445-4815
Country	:	US
Telephone Number	:	918-733-4219
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2015
Last Update Date	:	11/03/2015

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