Individual
UAKETHA BONNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1037 WILLIAM DR, SLIDELL, LA 70460-3992
(601) 365-4030
Mailing address
1037 WILLIAM DR, SLIDELL, LA 70460-3992
(601) 365-4030
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
011652115
LA
Other
Enumeration date
07/24/2024
Last updated
07/24/2024
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