Provider Demographics
NPI:1902282791
Name:BONNE ANNEE, LAURENCE (LPN)
Entity Type:Individual
Prefix:
First Name:LAURENCE
Middle Name:
Last Name:BONNE ANNEE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 ELLERY ST
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-2701
Mailing Address - Country:US
Mailing Address - Phone:646-833-6562
Mailing Address - Fax:
Practice Address - Street 1:105 ELLERY ST
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-2701
Practice Address - Country:US
Practice Address - Phone:646-833-6562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY322169-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse