1114255296 NPI number — MRS. DIADEMA LORENZO BONNELL R.N., MSN, CIC

Table of content: MRS. DIADEMA LORENZO BONNELL R.N., MSN, CIC (NPI 1114255296)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114255296 NPI number — MRS. DIADEMA LORENZO BONNELL R.N., MSN, CIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BONNELL
Provider First Name:
DIADEMA
Provider Middle Name:
LORENZO
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
R.N., MSN, CIC
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:
1114255296
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
480 CENTRAL AVE
Provider Second Line Business Mailing Address:
NAVAL HEALTH CLINIC HAWAII
Provider Business Mailing Address City Name:
PEARL HARBOR
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96860-4908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-471-1866
Provider Business Mailing Address Fax Number:
808-471-1855

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
480 CENTRAL AVE
Provider Second Line Business Practice Location Address:
NAVAL HEALTH CLINIC HAWAII
Provider Business Practice Location Address City Name:
PEARL HARBOR
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96860-4908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-471-1866
Provider Business Practice Location Address Fax Number:
808-471-1855
Provider Enumeration Date:
11/30/2009

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: 163WI0600X , with the licence number:  RN-38458 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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