Individual
CANDICE BONILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7865 LAKE SHORE RD, ANGOLA, NY 14006-9745
(716) 544-2770
Mailing address
7865 LAKE SHORE RD, ANGOLA, NY 14006-9745
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
635520
NY
Other
Enumeration date
11/01/2018
Last updated
11/03/2018
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