1710947635 NPI number — MRS. BONNIE RUTH FRUGE CFNP

Table of content: MRS. BONNIE RUTH FRUGE CFNP (NPI 1710947635)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710947635 NPI number — MRS. BONNIE RUTH FRUGE CFNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRUGE
Provider First Name:
BONNIE
Provider Middle Name:
RUTH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CFNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMITH
Provider Other First Name:
BONNIE
Provider Other Middle Name:
RUTH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CFNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1710947635
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/27/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P O BOX 122108
Provider Second Line Business Mailing Address:
DEPT 2108
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75312-2108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-480-8066
Provider Business Mailing Address Fax Number:
337-480-8064

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1717 OAK PARK BLVD FL 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE CHARLES
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70601-8990
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-494-6865
Provider Business Practice Location Address Fax Number:
337-494-6869
Provider Enumeration Date:
03/24/2006

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: 363LF0000X , with the licence number:  RN054410-AP03579 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1431869 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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