Individual
MR. KIVEN BONONGWE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
2240 E 53RD ST # B1, INDIANAPOLIS, IN 46220-3479
(317) 207-9256
Mailing address
9896 SOARING EAGLE LN, FISHERS, IN 46055-6192
(317) 640-5244
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
28191899A
IN
Other
Enumeration date
08/15/2023
Last updated
08/17/2023
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