Individual
BONITA WEGENAST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
580 GUARD ST, FRIDAY HARBOR, WA 98250-8044
(360) 370-5118
Mailing address
153 CORDOVA LN, FRIDAY HARBOR, WA 98250-8435
(306) 370-5118
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA00014562
WA
Other
Enumeration date
01/27/2011
Last updated
01/27/2011
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