Healthcare Provider Details

I. General information

NPI: 1215307178
Provider Name (Legal Business Name): BONNIE HOWARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2015
Last Update Date: 10/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8040 CLEARVISTA PKWY STE 440
INDIANAPOLIS IN
46256-5630
US

IV. Provider business mailing address

8921 BRADWELL PL #205
FISHERS IN
46037-8984
US

V. Phone/Fax

Practice location:
  • Phone: 317-497-6024
  • Fax: 317-497-2507
Mailing address:
  • Phone: 850-449-1608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number36002141A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: