Individual
BREANNA L BONNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1101 HIGHWAY 11 S, ELLISVILLE, MS 39437-4443
(601) 477-5771
Mailing address
38 PASS RD, STE A, GULFPORT, MS 39507-3107
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R867420
MS
Other
Enumeration date
02/08/2013
Last updated
12/27/2016
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