Individual
ELIZABETH BONANNI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
875 PERIMETER DR # MS 2302, MOSCOW, ID 83844-9803
(540) 604-7818
(208) 885-2862
Mailing address
301 LAUDER AVE APT 204, MOSCOW, ID 83843-4401
(540) 604-7818
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
10/02/2017
Last updated
10/02/2017
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