Individual
CHANAL BONNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1702 S MILLER RD, VALRICO, FL 33594-4736
(813) 758-5279
Mailing address
1702 S MILLER RD, VALRICO, FL 33594-4736
(813) 758-5279
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
5234520
FL
374J00000X
Doula
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5234520
—
FL
Enumeration date
08/04/2020
Last updated
08/04/2020
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