Provider Demographics
NPI:1730871419
Name:DEAN, BONNIE LYNN
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:LYNN
Last Name:DEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 HIGHBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:VERMILION
Mailing Address - State:OH
Mailing Address - Zip Code:44089-2027
Mailing Address - Country:US
Mailing Address - Phone:440-522-8310
Mailing Address - Fax:
Practice Address - Street 1:637 HIGHBRIDGE RD
Practice Address - Street 2:
Practice Address - City:VERMILION
Practice Address - State:OH
Practice Address - Zip Code:44089-2027
Practice Address - Country:US
Practice Address - Phone:440-522-8310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL006266A42347B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347B00000XTransportation ServicesBus