MEDICARE: STEVEN WAYNE BONNETTE

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	PN 149682	OH

General Provider Information

NPI Number	:	1750637989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN WAYNE BONNETTE

Provider Business Mailing Address
First Line	:	6249 SHARON WOODS BLVD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-2145
Country	:	US
Telephone Number	:	614-891-8343
Fax Number	:

Provider Business Practice Location Address
First Line	:	6249 SHARON WOODS BLVD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-2145
Country	:	US
Telephone Number	:	614-891-8343
Fax Number	:

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

Provider Enumeration Date	:	07/25/2012
Last Update Date	:	07/25/2012

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Directions to “ STEVEN WAYNE BONNETTE ” Practice Location

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