Bonnie J Clark, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

217212-1 Issued in NY

Practice address

47 Caton Rd
Corning, NY 14830-3741

Phone

(607) 937-4385

NPI assigned

Aug 13, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Bonnie J White Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1344816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1344816000000",
    "number": "1104173822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47 CATON RD",
            "city": "CORNING",
            "state": "NY",
            "postal_code": "148303741",
            "telephone_number": "607-937-4385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "47 CATON RD",
            "city": "CORNING",
            "state": "NY",
            "postal_code": "148303741",
            "telephone_number": "607-937-4385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "BONNIE",
        "middle_name": "J",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-08-13",
        "last_updated": "2012-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "217212-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BONNIE",
            "last_name": "WHITE",
            "middle_name": "J",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Marissa S Chisdock, RPH
• Choice Physical Therapy, PLLC
• Jae W Chung, M.D.
• Michael Cilip Jr., MD
• Bonnie Clark, LCSW-R
• Candice A Cleveland, LCSWR
• Andrea C Cohen, LCSW
• Daniel G Cohen, LCSW
• Cheryl Virginia Colegrove-Landon, RN
• Katherine Ann Colyer, PT

• All providers in Corning, NY
• Licensed Practical Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.