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Organization

BONAFIDE WELLNESS LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MICHAEL BONIFACIO PMHNP-BC (CEO)
(872) 265-1588
Entity
Organization

Contact information

Practice address
2918 W LOGAN BLVD UNIT 3E, CHICAGO, IL 60647-1732
(872) 265-1588
Mailing address
2501 CHATHAM RD STE N, SPRINGFIELD, IL 62704-4188
(872) 265-1588

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary

Other

Enumeration date
04/29/2026
Last updated
04/29/2026
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