Individual
MRS. LEIGH ANN BONVILLAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-4124
Mailing address
4501 HWY 39 N APT 13F, MERIDIAN, MS 39301-1076
(601) 479-2924
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R869889
MS
Other
Enumeration date
01/15/2009
Last updated
07/25/2011
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