MEDICARE: BONITA KNUCKLES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374J00000X	Doula
2	163WS0200X	School Registered Nurse	541664	CA

General Provider Information

NPI Number	:	1932731916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONITA KNUCKLES

Provider Business Mailing Address
First Line	:	1922 MOOSUP CT
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-6648
Country	:	US
Telephone Number	:	707-971-5024
Fax Number	:

Provider Business Practice Location Address
First Line	:	1922 MOOSUP CT
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-6648
Country	:	US
Telephone Number	:	707-971-5024
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2020
Last Update Date	:	04/06/2026

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Directions to “ BONITA KNUCKLES ” Practice Location

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