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General NPI Number Information
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NPI Number | 1740545771
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Entity Type | Individual
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Provider Name | AUTUMN RACHELLE LEWIS-BONIFAZI CSA
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Gender | Female
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Dates
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Enumeration Date | 07/05/2012
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Last Update Date | 07/05/2012
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Provider Practice Location Address
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Address Line | 2447 WESTHOFF CT
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City | CONROE
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State | TX
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Zip | 77384-3366
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Country | US
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Telephone | 832-654-9379
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Fax |
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Provider Business Mailing Address
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Address Line | 2257 N LOOP 336 W SUITE 140-407
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City | CONROE
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State | TX
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Zip | 77304-3566
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Country | US
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Telephone |
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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 | 246ZS0410X
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Taxonomy Name | Surgical Technologist
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License Number | 3899
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License Number State | TX
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