Individual
ANNA BONICKY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4094 MAJESTIC LN, SUITE 298, FAIRFAX, VA 22033-2104
(703) 631-1745
Mailing address
2800 HICKORY ST, ALEXANDRIA, VA 22305-2511
(571) 217-3070
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110-005620
VA
Other
Enumeration date
01/23/2017
Last updated
01/23/2017
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