Individual
CHANELL R BONNETTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1108 UNION ST, SPARTANBURG, SC 29302-3320
(803) 378-2550
Mailing address
1108 UNION ST, SPARTANBURG, SC 29302-3320
(803) 378-2550
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1182636
NCCPA ID
—
Enumeration date
10/22/2021
Last updated
10/22/2021
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