Bonnie Dufault
Individual provider Active NPI Attendant Care Provider · Indiana, IA
NPI 1023667995 · NPPES record last updated Sep 4, 2019
Key facts
- NPI
- 1023667995
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Attendant Care Provider 3747A0650X
- Practice address
- 2402 West Euclid Ave
Indiana, IA 50125 - Phone
- (225) 315-7572
- NPI assigned
- Sep 4, 2019
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Attendant Care Provider | 3747A0650X | Yes |
Addresses
Primary practice location
2402 West Euclid Ave
Indiana, IA 50125
Mailing address
2402 West Euclid Ave
Indiana, IA 50125
Phone (225) 315-7572
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 4, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.