Bonnie Jean Tibbitts, OTR

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1537026 Issued in WI

Practice address

4901 N Clairemont Ave
Eau Claire, WI 54703-3869

Phone

(715) 874-5489

NPI assigned

May 10, 2008

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 identifiers 1

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": "1210377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210377600000",
    "number": "1649447517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1405 TRUAX BLVD",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547031474",
            "telephone_number": "715-552-1030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4901 N CLAIREMONT AVE",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547033869",
            "telephone_number": "715-874-5489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIBBITTS",
        "first_name": "BONNIE",
        "middle_name": "JEAN",
        "name_prefix": "Mrs.",
        "credential": "OTR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-05-10",
        "last_updated": "2008-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "1537026",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42058800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Jennifer J Thyssen, NP
• Alay Gebremedhin Tikue, MD
• Robert J Tillotson, DO
• Lauren Christine Tilseth
• Iansa Tinkle, LPC, MT-BC
• Sadrionne Kuira Tinnon

• Skilled Nursing Facility in Eau Claire, WI
• Providers in Eau Claire, WI by specialty
• Skilled Nursing Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2008; 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.