Healthcare Provider Details

I. General information

NPI: 1255063491
Provider Name (Legal Business Name): BONNIE ELIZABETH FAYER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BONNIE ELIZABETH YEAMANS

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 EASTON AVE
NEW BRUNSWICK NJ
08901-1766
US

IV. Provider business mailing address

254 EASTON AVE
NEW BRUNSWICK NJ
08901-1766
US

V. Phone/Fax

Practice location:
  • Phone: 732-745-8600
  • Fax: 732-828-6351
Mailing address:
  • Phone: 732-745-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number26NR15881400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: