Healthcare Provider Details

I. General information

NPI: 1952117418
Provider Name (Legal Business Name): BONNIE WILLIAMS LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2024
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 2571
MONROE LA
71207-2571
US

IV. Provider business mailing address

1307 SPEED AVE
MONROE LA
71201-4333
US

V. Phone/Fax

Practice location:
  • Phone: 318-582-5069
  • Fax: 318-582-5220
Mailing address:
  • Phone: 318-355-1779
  • Fax: 318-582-5220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN240367
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: