MEDICARE: JOEVONNA BONNER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	374U00000X	Home Health Aide
2	374J00000X	Doula	CA
3	172V00000X	Community Health Worker	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710750039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEVONNA BONNER

Provider Business Mailing Address
First Line	:	5614 N FRESNO ST STE 111
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93710-6034
Country	:	US
Telephone Number	:	559-578-0306
Fax Number	:

Provider Business Practice Location Address
First Line	:	5614 N FRESNO ST STE 111
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93710-6034
Country	:	US
Telephone Number	:	559-578-0306
Fax Number	:

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

Provider Enumeration Date	:	10/31/2023
Last Update Date	:	06/28/2024

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Directions to “ JOEVONNA BONNER ” Practice Location

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