Individual
PHYLLIS ANN BONAT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
408 RIATA, GATESVILLE, TX 76528-2743
(254) 288-6663
Mailing address
3003 BATALION AVENUE FORT HOOD, TEXAS, FPO, AA 76544
(254) 288-6663
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
667303
TX
Other
Enumeration date
06/11/2021
Last updated
06/11/2021
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