Individual
JONATHAN RENE BRONISTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
APN
Contact information
Practice address
603 S DIVISION ST, LAVACA, AR 72941-4129
(479) 674-9181
(479) 674-8105
Mailing address
603 S DIVISION ST, LAVACA, AR 72941-4129
(479) 674-9181
(479) 674-8105
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
A03206
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A03206
LICENSE NUMBER
AR
Enumeration date
03/17/2009
Last updated
09/23/2015
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