Provider Demographics
NPI:1588632103
Name:BONHAM, PAMELA S (NP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:S
Last Name:BONHAM
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:21 SPURS LN
Mailing Address - Street 2:230B
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1669
Mailing Address - Country:US
Mailing Address - Phone:210-690-7400
Mailing Address - Fax:210-690-7405
Practice Address - Street 1:21 SPURS LN
Practice Address - Street 2:230B
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1669
Practice Address - Country:US
Practice Address - Phone:210-690-7400
Practice Address - Fax:210-690-7405
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2014-09-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX2005004887-22363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX364515ZJD9Medicare PIN