Healthcare Provider Details

I. General information

NPI: 1184556961
Provider Name (Legal Business Name): BONKE REMEZO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1429 N 21ST ST APT 4
BISMARCK ND
58501-2930
US

IV. Provider business mailing address

1429 N 21ST ST APT 4
BISMARCK ND
58501-2930
US

V. Phone/Fax

Practice location:
  • Phone: 512-560-3780
  • Fax:
Mailing address:
  • Phone: 512-560-3780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: