Healthcare Provider Details

I. General information

NPI: 1164618328
Provider Name (Legal Business Name): BONNIE HERMESMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 12/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 THREE SPRINGS BLVD SUITE 255
DURANGO CO
81301-8296
US

IV. Provider business mailing address

1010 THREE SPRINGS BLVD SUITE 255
DURANGO CO
81301-8296
US

V. Phone/Fax

Practice location:
  • Phone: 970-764-3810
  • Fax: 970-764-3824
Mailing address:
  • Phone: 970-764-3810
  • Fax: 970-764-3824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC2100X
TaxonomyContinence Care Registered Nurse
License Number31200
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number31200
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code163WX1500X
TaxonomyOstomy Care Registered Nurse
License Number31200
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: