Healthcare Provider Details

I. General information

NPI: 1710947635
Provider Name (Legal Business Name): BONNIE RUTH FRUGE CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BONNIE RUTH SMITH CFNP

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 06/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 OAK PARK BLVD FL 3
LAKE CHARLES LA
70601-8990
US

IV. Provider business mailing address

P O BOX 122108 DEPT 2108
DALLAS TX
75312-2108
US

V. Phone/Fax

Practice location:
  • Phone: 337-494-6865
  • Fax: 337-494-6869
Mailing address:
  • Phone: 337-480-8066
  • Fax: 337-480-8064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN054410-AP03579
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: