Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1101X | Ophthalmic Assistant | 167743 | NV |
NPI | 1831703990 |
---|---|
Provider Name | Traciann Bonner |
First Address | Reno, NV 89511-1825 |
Second Address | Reno, NV 89511-1825 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2020 |
Last Update Date | 04/09/2020 |