Spade, Bonita A
Spade, Bonita A is an individual health care provider with primary practice located at 2845 Tricom St , North Charleston SC 29406-9172. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Adult Health, which is considered as her primary health care specialty. Spade, Bonita A can be contacted via phone (843) 797-1770.Contact Information
Primary practice address
2845 Tricom St
North Charleston SC 29406-9172
Phone: (843) 797-1770
Fax: (843) 553-1498
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Adult Health | 363LA2200X | R64665 | South Carolina |
Profile Details
| NPI number | 1861569329 |
|---|---|
| LBN Legal business name | Spade, Bonita A |
| Credentials | FNP,CDE |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 29th, 2006 |
| Last updated | Jul 9th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1861569329 | NPPES |
| South Carolina | MEDICAID | NP0283 | |
| South Carolina | Other | R64665 |
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