Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 48082-020 | WI |
Y | 111NI0900X | Internist | 48082-020 | WI |
NPI | 1003025289 |
---|---|
Provider Name | Julia Bonner |
First Address | Whitefish Bay, WI 53217-4811 |
Second Address | Milwaukee, WI 53211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 08/07/2007 |