Individual
BONITA R QUALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
47710 INTERLAKE DR, KENAI, AK 99611-9694
(907) 776-8684
(907) 776-8805
Mailing address
47710 INTERLAKE DR, KENAI, AK 99611-9694
(907) 776-8684
(907) 776-8805
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
100608
AK
310400000X
Assisted Living Facility
Primary
224
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
RL 3719
—
AK
05
—
RL4771
—
AK
Enumeration date
03/13/2007
Last updated
08/31/2007
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