Individual
MICHAEL P BONGIORNO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1741 SYCAMORE AVE, KINGMAN, AZ 86409-0927
(928) 757-8111
Mailing address
3798 E LASS AVE, KINGMAN, AZ 86409-0817
(440) 487-6475
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
PN.135636-M-IV
OH
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
0027525
OH
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
71016143A
IN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP246670
AZ
Other
Enumeration date
04/12/2010
Last updated
05/10/2026
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