MEDICARE: EMILY FAIRCHILD BONISTEEL LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	4703105617	MI

General Provider Information

NPI Number	:	1346636925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY FAIRCHILD BONISTEEL LPN

Provider Business Mailing Address
First Line	:	6815 NORVELL RD
Second Line	:
City	:	BROOKLYN
State	:	MI
Zip	:	49230-9531
Country	:	US
Telephone Number	:	734-709-2924
Fax Number	:

Provider Business Practice Location Address
First Line	:	6815 NORVELL RD
Second Line	:
City	:	BROOKLYN
State	:	MI
Zip	:	49230-9531
Country	:	US
Telephone Number	:	734-709-2924
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2015
Last Update Date	:	04/10/2015

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