Healthcare Provider Details

I. General information

NPI: 1568520211
Provider Name (Legal Business Name): BONNIE M RICHTER R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BONITA M KRUSSOW R.N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7305 N MILITARY TRL
RIVIERA BEACH FL
33410-7417
US

IV. Provider business mailing address

7030 42ND WAY N
WEST PALM BEACH FL
33404-5830
US

V. Phone/Fax

Practice location:
  • Phone: 561-422-8370
  • Fax:
Mailing address:
  • Phone: 561-840-9829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberR067821-2
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: