Provider Demographics
NPI:1790894731
Name:BONNETT, AMY (DOM)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BONNETT
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
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Mailing Address - Street 1:1350 JACKIE RD SE
Mailing Address - Street 2:#102
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1519
Mailing Address - Country:US
Mailing Address - Phone:505-896-6965
Mailing Address - Fax:505-217-3791
Practice Address - Street 1:1350 JACKIE RD SE
Practice Address - Street 2:#102
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1519
Practice Address - Country:US
Practice Address - Phone:505-896-6965
Practice Address - Fax:505-217-3791
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2013-03-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM906171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist