Organization
FACE 2 FACE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN RENE BRONISTE APN (OWNER)
(479) 208-3471
Entity
Organization
Contact information
Practice address
1306 SYLVAN HILLS RD, VAN BUREN, AR 72956-2565
(479) 208-3471
(888) 987-1841
Mailing address
PO BOX 140, LAVACA, AR 72941-0140
(479) 674-9181
(479) 674-8105
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
198286004
—
AR
Enumeration date
12/27/2012
Last updated
09/16/2019
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