Healthcare Provider Details

I. General information

NPI: 1861812232
Provider Name (Legal Business Name): MS. LACHIA BONNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2014
Last Update Date: 04/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9412 PIERPONT AVE
CLEVELAND OH
44108-3235
US

IV. Provider business mailing address

9412 PIERPONT AVE
CLEVELAND OH
44108-3235
US

V. Phone/Fax

Practice location:
  • Phone: 216-254-5602
  • Fax:
Mailing address:
  • Phone: 216-254-5602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number400046931101
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: