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NPI Code Detail

MEDICARE: BONNY M HADACEK RN

MEDICARE: BONNY M HADACEK RN
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
1163WC1500XCommunity Health Registered NurseRN0000037819TN

General Provider Information

NPI Number : 1760607881
Entity Type Code : Individual
Provider Name (Legal Business Name) : BONNY M HADACEK RN
Provider Business Mailing Address
First Line : 9303 SEASONS DR
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37421-5323
Country : US
Telephone Number : 423-899-9703
Fax Number :
Provider Business Practice Location Address
First Line : 5520 HIGH ST
Second Line :
City : OOLTEWAH
State : TN
Zip : 37363-8131
Country : US
Telephone Number : 423-238-4269
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2007
Last Update Date : 07/08/2007

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