MEDICARE: MRS. BONNIE BLEVINS R.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	364S00000X	Clinical Nurse Specialist	309-001816	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	041-220150	OTHER		ILLINOIS LICENSE

General Provider Information

NPI Number	:	1992894331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BONNIE BLEVINS R.N.

Provider Business Mailing Address
First Line	:	1150 STATE HIGHWAY 248 STE 200
Second Line	:
City	:	BRANSON
State	:	MO
Zip	:	65616-4186
Country	:	US
Telephone Number	:	417-336-4112
Fax Number	:	417-335-4684

Provider Business Practice Location Address
First Line	:	1150 STATE HIGHWAY 248
Second Line	:	SUITE 200
City	:	BRANSON
State	:	MO
Zip	:	65616-3758
Country	:	US
Telephone Number	:	417-336-4112
Fax Number	:	417-335-4684

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	12/20/2013

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