Provider Demographics
NPI:1023227394
Name:BONNET-ENGEBRETSON, LEONOR NMN (MD)
Entity type:Individual
Prefix:
First Name:LEONOR
Middle Name:NMN
Last Name:BONNET-ENGEBRETSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3212 WALNUT RDG
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-8745
Mailing Address - Country:US
Mailing Address - Phone:770-964-2216
Mailing Address - Fax:770-964-3783
Practice Address - Street 1:3212 WALNUT RDG
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-8745
Practice Address - Country:US
Practice Address - Phone:770-964-2216
Practice Address - Fax:770-964-3783
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2008-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9760261QP2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health