Provider Demographics
NPI:1780571232
Name:BONNER, MUNEERAH SHABAZZ (PMHNP)
Entity type:Individual
Prefix:
First Name:MUNEERAH
Middle Name:SHABAZZ
Last Name:BONNER
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 RIDGEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36869-3437
Mailing Address - Country:US
Mailing Address - Phone:706-575-0822
Mailing Address - Fax:
Practice Address - Street 1:31 RIDGEBROOK DR
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36869-3437
Practice Address - Country:US
Practice Address - Phone:706-575-0822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-185423363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health