Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | #1306 | ME |
N | 208D00000X | General Practice Physician | 1306 | ME |
NPI | 1265579015 |
---|---|
Provider Name | Bonnie Joan Sendzicki |
First Address | Harrison, ME 04040 |
Second Address | Waterford, ME 04088 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E37145 | (02) |