Individual
BONITA J O'REILLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
8191 MOORSBRIDGE RD STE A, PORTAGE, MI 49024-7417
(269) 312-8170
(269) 762-4785
Mailing address
5110 STONEY BROOK RD, KALAMAZOO, MI 49009-3846
(269) 372-3068
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
47-04-102421
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104545456
—
MI
05
—
104545465
—
MI
05
—
104545483
—
MI
05
—
104545492
—
MI
Enumeration date
08/12/2005
Last updated
03/17/2018
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