| NPI | 1811533284 |
|---|---|
| Former Name | BONNIE WIDENHOUSE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9112677) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-11796) |
| Enumeration Date | 2019-11-20 |
| Last Update Date | 2022-07-18 |