Provider Demographics
NPI:1114070786
Name:BONILLA, MARY KATE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KATE
Last Name:BONILLA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:102 MCADOO DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-8409
Mailing Address - Country:US
Mailing Address - Phone:256-772-7530
Mailing Address - Fax:256-772-5968
Practice Address - Street 1:400 WHITESPORT DR SW SUITE 201
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6429
Practice Address - Country:US
Practice Address - Phone:256-882-9777
Practice Address - Fax:256-882-9188
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2235552363L00000X
AL1-038037363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily