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General NPI Number Information
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NPI Number | 1619331667
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Entity Type | Individual
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Provider Name | AMY BONNER LMT
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Gender | Female
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Dates
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Enumeration Date | 04/06/2016
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Last Update Date | 12/13/2023
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Provider Practice Location Address
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Address Line | 5301 MCAULEY DR
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City | YPSILANTI
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State | MI
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Zip | 48197-1051
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Country | US
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Telephone | 313-400-1833
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Fax |
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Provider Business Mailing Address
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Address Line | 5301 MCAULEY DR
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City | YPSILANTI
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State | MI
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Zip | 48197-1051
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Country | US
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Telephone | 313-400-1833
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | L2399307
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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