Individual
MRS. KATELYN ROSE BONVOLANTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGPCNP-BC
Contact information
Practice address
414 UNION ST STE 100, MILFORD, MI 48381-1989
(248) 676-8889
Mailing address
14729 BLUE SKIES ST, LIVONIA, MI 48154-4965
(734) 788-5313
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
4704292862
MI
Other
Enumeration date
10/10/2017
Last updated
10/10/2017
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