=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225338809
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAROL BOND
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2010
-----------------------------------------------------
Last Update Date | 10/28/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 445 S MAIN ST
-----------------------------------------------------
City | OREGON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53575-1540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-579-4882
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 445 S MAIN ST
-----------------------------------------------------
City | OREGON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53575-1540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-579-4882
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RN
-----------------------------------------------------
Name | CAROL BOND
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 406-579-4882
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 313M00000X
-----------------------------------------------------
Taxonomy Name | Nursing Facility/Intermediate Care Facility
-----------------------------------------------------
License Number | 171785-30
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------