MEDICARE: MRS. MARIE LOUISE BOND RN

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	163WA0400X	Addiction (Substance Use Disorder) Registered Nurse	RN139920	GA

General Provider Information

NPI Number	:	1851533483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIE LOUISE BOND RN

Provider Business Mailing Address
First Line	:	3509 MABRY RD
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30504-5755
Country	:	US
Telephone Number	:	678-207-1199
Fax Number	:	678-207-1620

Provider Business Practice Location Address
First Line	:	3509 MABRY RD
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30504-5755
Country	:	US
Telephone Number	:	678-207-1199
Fax Number	:	678-207-1620

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

Provider Enumeration Date	:	03/27/2009
Last Update Date	:	03/27/2009

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