Healthcare Provider Details

I. General information

NPI: 1922310218
Provider Name (Legal Business Name): BONNIE L BENDALL CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BONNIE C MARSHALL CRNP

II. Dates (important events)

Enumeration Date: 07/02/2010
Last Update Date: 09/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13150 HIGHWAY 43 STE 10
RUSSELLVILLE AL
35653-4566
US

IV. Provider business mailing address

13150 HIGHWAY 43 STE 10
RUSSELLVILLE AL
35653-4566
US

V. Phone/Fax

Practice location:
  • Phone: 256-331-2092
  • Fax: 256-331-2096
Mailing address:
  • Phone: 256-331-2092
  • Fax: 256-331-2096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1107757
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: