Bonita C Yeshurun, RN

Primary specialty

Administrator Registered NurseTaxonomy code 163WA2000X

License

RN288265 Issued in GA

Practice address

688 Bentleaf Dr
Dallas, GA 30132-1129

Phone

(678) 860-4430

NPI assigned

Nov 9, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1731110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733097600000",
    "number": "1477377265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 PINE VALLEY RD STE 113",
            "city": "HIRAM",
            "state": "GA",
            "postal_code": "301414976",
            "telephone_number": "678-996-5030",
            "fax_number": "678-996-5021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "688 BENTLEAF DR",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "301321129",
            "telephone_number": "678-860-4430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YESHURUN",
        "first_name": "BONITA",
        "middle_name": "C",
        "name_prefix": "Mrs.",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-11-09",
        "last_updated": "2024-12-02",
        "certification_date": "2024-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WA2000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Administrator",
            "state": "GA",
            "license": "RN288265",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clifton Young
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• Administrator Registered Nurse in Dallas, GA
• Providers in Dallas, GA by specialty
• Administrator Registered Nurse in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2024; 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.