Individual
NICHELLE BONAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
17114 PASSAGE AVE APT 108, BELLFLOWER, CA 90706-5561
(562) 619-0483
Mailing address
17114 PASSAGE AVE APT 108, BELLFLOWER, CA 90706-5561
(562) 619-0483
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
708047
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
NA
CA
Enumeration date
04/16/2021
Last updated
04/16/2021
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