1194963215 NPI number — MRS. AUGUSTINA B BONSU NP

Table of content: MRS. AUGUSTINA B BONSU NP (NPI 1194963215)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194963215 NPI number — MRS. AUGUSTINA B BONSU NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BONSU
Provider First Name:
AUGUSTINA
Provider Middle Name:
B
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194963215
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
850 CENTRAL PKWY E
Provider Second Line Business Mailing Address:
SUITE 275
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75074-5561
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-881-4688
Provider Business Mailing Address Fax Number:
972-881-4609

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
850 CENTRAL PKWY E
Provider Second Line Business Practice Location Address:
SUITE 275
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75074-5561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-881-4688
Provider Business Practice Location Address Fax Number:
972-881-4609
Provider Enumeration Date:
01/27/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  A0808392 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 318353YNVL . This is a "MEDICARE IND" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 2035487-01 . This is a "GROUP TPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00115X . This is a "MEDICARE GROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8916ND . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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