Sandra J Bonom, CFNP
Individual provider Active NPI Family Health Clinical Nurse Specialist · Brandon, MS
NPI 1285815548 · NPPES record last updated Nov 15, 2007
Key facts
- NPI
- 1285815548
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Health Clinical Nurse Specialist 364SF0001X
- License
- R100760 (MS)
- Practice address
- 126 Pine Ridge Cir
Brandon, MS 39047-7514 - Phone
- (601) 829-3734
- NPI assigned
- Nov 15, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R100760 | MS | MD | Family Health Clinical Nurse Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Health Clinical Nurse Specialist | 364SF0001X | R100760 | MS | Yes |
Addresses
Primary practice location
126 Pine Ridge Cir
Brandon, MS 39047-7514
Mailing address
126 Pine Ridge Cir
Brandon, MS 39047-7514
Phone (601) 829-3734
Other providers in Brandon, MS
- Noralyn Christina Blalock-Perkins
- Jasmine Arlean Blanks
- Bleigh Incorporated
- Kiessha Body
- Terrell Lane Boler
- Ritha G Bookert
- Melissa Bordelon Shields
- Merikelly Borgognoni
- Lyinka Nicole Boston
- Boudreaux Mental Health Services
All providers in Brandon, MS · Family Health Clinical Nurse Specialist in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 15, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.