Provider Demographics
NPI:1114986593
Name:LABONNE, AWILDA MARRERO (PA-C)
Entity Type:Individual
Prefix:MS
First Name:AWILDA
Middle Name:MARRERO
Last Name:LABONNE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 W KENT ST STE 103
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-9913
Mailing Address - Country:US
Mailing Address - Phone:423-648-2273
Mailing Address - Fax:423-206-4625
Practice Address - Street 1:13 W KENT ST STE 103
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405-9913
Practice Address - Country:US
Practice Address - Phone:423-648-2273
Practice Address - Fax:423-206-4625
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN03307363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL363AMO700XOtherTAXONOMY
ML1369847OtherDEA