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Individual
SALLY DIANE BONHAM
Active
Individual
SALLY DIANE BONHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BSN, MSN, FNP, IBCLC
Taxonomy
Speciality
Code
Description
License number
State
163WL0100X
Lactation Consultant (Registered Nurse)
638280
TX
363LF0000X
Family Nurse Practitioner
Primary
1182184
TX
Other
Enumeration date
01/31/2024
Last updated
10/29/2025
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