Provider Demographics
NPI:1538200233
Name:BONNICK MURRAY, BLANCHE Y (MD)
Entity type:Individual
Prefix:
First Name:BLANCHE
Middle Name:Y
Last Name:BONNICK MURRAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BLANCHE
Other - Middle Name:Y
Other - Last Name:BONNICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1701 BEARDEN DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4189
Mailing Address - Country:US
Mailing Address - Phone:702-310-9110
Mailing Address - Fax:702-310-9114
Practice Address - Street 1:2500 WIGWAM PKWY
Practice Address - Street 2:SUITE 111
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7112
Practice Address - Country:US
Practice Address - Phone:702-407-1561
Practice Address - Fax:702-407-1563
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9590207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1538200233Medicaid
CAF36524Medicare UPIN