Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MD60462413 | WA |
Y | 208600000X | Surgeon | MD60462413 | WA |
N | 2082S0105X | Plastic Hand Surgeon | 53688-20 | WI |
N | 2082S0105X | Plastic Hand Surgeon | MD60462413 | WA |
NPI | 1447414479 |
---|---|
Provider Name | Laura A Bonneau |
First Address | Liberty Lake, WA 99019-0421 |
Second Address | Spokane, WA 99204-2450 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2008 |
Last Update Date | 21/07/2021 |