| NPI | 1609029644 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWN P BONILLA Owner 405-485-9588 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: OK R0068442) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: OK R0068442) |
| Enumeration Date | 2008-11-03 |
| Last Update Date | 2023-12-13 |