Provider Demographics
NPI:1013567817
Name:MBONIFOR, PATIENCE S (RN, DNP)
Entity Type:Individual
Prefix:
First Name:PATIENCE
Middle Name:S
Last Name:MBONIFOR
Suffix:
Gender:F
Credentials:RN, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55041-1251
Mailing Address - Country:US
Mailing Address - Phone:651-724-2400
Mailing Address - Fax:
Practice Address - Street 1:1315 N 7TH ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:MN
Practice Address - Zip Code:55041-1251
Practice Address - Country:US
Practice Address - Phone:651-724-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-13
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1490237163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse