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General NPI Number Information
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NPI Number | 1942527155
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Entity Type | Individual
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Provider Name | BONITA NICHELLE GREER L.P.N.
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Gender | Female
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Dates
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Enumeration Date | 04/27/2010
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Last Update Date | 04/27/2010
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Provider Practice Location Address
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Address Line | 2442 HIGH RIDGE TRL
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City | FITCHBURG
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State | WI
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Zip | 53713-3630
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Country | US
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Telephone | 608-235-6626
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Fax |
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Provider Business Mailing Address
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Address Line | 2442 HIGH RIDGE TRL
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City | FITCHBURG
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State | WI
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Zip | 53713-3630
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Country | US
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Telephone | 608-235-6626
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | #308422-031
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 043108126
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License Number State | IL
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