Individual
HARLEY BONNIVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP-PC
Contact information
Practice address
119 BULIFANTS BLVD, WILLIAMSBURG, VA 23188-5747
(757) 564-7337
Mailing address
2513 SPRING BRIDGE PL, SANDSTON, VA 23150-4409
(804) 971-3420
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
0024184256
VA
Other
Enumeration date
10/11/2022
Last updated
10/11/2022
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