Individual
JILLIAN WAGNER BONAROTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
100 BREWSTER BLVD, CAMP LEJEUNE, NC 28547-2575
(910) 450-3905
Mailing address
100 BREWSTER BLVD, CAMP LEJEUNE, NC 28547-2575
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD471098
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/01/2017
Last updated
05/12/2025
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