Individual
MS. BONNY LEE SAXON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BA, LMT
Contact information
Practice address
129 WATER ST, RANDOLPH, ME 04346-5101
(207) 582-8158
Mailing address
129 WATER ST, RANDOLPH, ME 04346-5101
(207) 582-8158
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
417
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
VC0000105553
—
ME
Enumeration date
11/24/2008
Last updated
11/24/2008
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