Individual
BONESHA BRUNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11428 E 20TH ST, UNIT A, TULSA, OK 74128-6451
(918) 878-7877
Mailing address
11428 E 20TH ST, UNIT A, TULSA, OK 74128-6451
(918) 878-7877
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000000
—
OK
Enumeration date
03/08/2013
Last updated
03/08/2013
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