MEDICARE: PAMELA S BONHAM NP

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	363LF0000X	Family Nurse Practitioner	2005004887-22	TX

General Provider Information

NPI Number	:	1588632103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA S BONHAM NP

Provider Business Mailing Address
First Line	:	21 SPURS LN
Second Line	:	230B
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1669
Country	:	US
Telephone Number	:	210-690-7400
Fax Number	:	210-690-7405

Provider Business Practice Location Address
First Line	:	21 SPURS LN
Second Line	:	230B
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1669
Country	:	US
Telephone Number	:	210-690-7400
Fax Number	:	210-690-7405

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	09/27/2014

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