Healthcare Provider Details

I. General information

NPI: 1326426909
Provider Name (Legal Business Name): KNICE BONNER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2015
Last Update Date: 05/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3347 EVANSTON AVE
CINCINNATI OH
45207-1914
US

IV. Provider business mailing address

3347 EVANSTON AVE
CINCINNATI OH
45207
US

V. Phone/Fax

Practice location:
  • Phone: 513-338-3165
  • Fax:
Mailing address:
  • Phone: 513-338-3165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number153962
License Number StateOH

VIII. Authorized Official

Name: MS. KNICE BONNER
Title or Position: LICENSE PRACTICAL NURSING
Credential: LPN
Phone: 513-338-3165