Organization
HEALTHCARE STAT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAWN P BONILLA ARNP (OWNER)
(405) 485-9588
Entity
Organization
Contact information
Practice address
1619 S 4TH ST, CHICKASHA, OK 73018-5860
(405) 224-6700
(405) 224-6707
Mailing address
PO BOX 1126, NORMAN, OK 73070-1126
(405) 659-5656
(405) 701-5421
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
R0068442
OK
363LP2300X
Primary Care Nurse Practitioner
R0068442
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200226680A
—
OK
Enumeration date
11/03/2008
Last updated
12/13/2023
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