Individual
BOONPON THONGTEUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
186 KIMEL PARK DR, WINSTON-SALEM, NC 27103-6946
(336) 277-2000
(336) 277-2050
Mailing address
PO BOX 751803, CHARLOTTE, NC 28275-1803
(336) 277-2000
(336) 277-2050
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
900419
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1285682310
WSCA GRP NPI #
NC
05
—
7005137
—
NC
Enumeration date
03/28/2006
Last updated
10/28/2020
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