Healthcare Provider Details

I. General information

NPI: 1326257007
Provider Name (Legal Business Name): BONNIE SUE HARRINGTON P.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 SANTA BARBARA BLVD
CAPE CORAL FL
33991-2031
US

IV. Provider business mailing address

601 HAYNES AVE
SHREVEPORT LA
71105-3827
US

V. Phone/Fax

Practice location:
  • Phone: 239-242-0549
  • Fax: 239-242-9549
Mailing address:
  • Phone: 318-469-5212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberA4150
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: