Individual
MACKENZIE BONNEWITZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2530 N ELM PL, BROKEN ARROW, OK 74012-1285
(918) 994-1402
(918) 512-4806
Mailing address
2530 N ELM PL, BROKEN ARROW, OK 74012-1285
(918) 994-1402
(918) 512-4806
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
OK
Other
Enumeration date
08/21/2023
Last updated
01/07/2026
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