Provider Demographics
NPI:1649614942
Name:BONNEVILLE, ALICIA (CNA)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:BONNEVILLE
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 REEVES ST
Mailing Address - Street 2:APT 1R
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01607-1303
Mailing Address - Country:US
Mailing Address - Phone:508-963-9051
Mailing Address - Fax:
Practice Address - Street 1:3 REEVES ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01607-1303
Practice Address - Country:US
Practice Address - Phone:508-963-9051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAA253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care