Provider Demographics
NPI:1285527549
Name:NICKERSON, BONNIE LEE (LPN)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:LEE
Last Name:NICKERSON
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 1:8819 W VICTORIA AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7193
Mailing Address - Country:US
Mailing Address - Phone:509-783-1851
Mailing Address - Fax:
Practice Address - Street 1:8819 W VICTORIA AVE STE 110
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7193
Practice Address - Country:US
Practice Address - Phone:509-783-1851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60293564164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse