Active NPI
Autumn Rachelle Lewis-Bonifazi, CSA
- Surgical Technologist
- Conroe, TX
National Provider Identifier
1740545771
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Technologist
- License
- 3899
- Practice address
- 2447 Westhoff CT
Conroe, TX 77384-3366 - Phone
- (832) 654-9379
- NPI assigned
- Jul 5, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Technologist | 246ZS0410X | 3899 | TX | Primary |
Addresses
Primary practice location
2447 Westhoff CT
Conroe, TX 77384-3366
Mailing address
2257 N Loop 336 W
Suite 140-407
Conroe, TX 77304-3566
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3899 | TX | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1341446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1341446400000",
"number": "1740545771",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2257 N LOOP 336 W",
"address_2": "SUITE 140-407",
"city": "CONROE",
"state": "TX",
"postal_code": "773043566"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2447 WESTHOFF CT",
"city": "CONROE",
"state": "TX",
"postal_code": "773843366",
"telephone_number": "832-654-9379"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEWIS-BONIFAZI",
"first_name": "AUTUMN",
"middle_name": "RACHELLE",
"credential": "CSA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-07-05",
"last_updated": "2012-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "246ZS0410X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Technologist",
"state": "TX",
"license": "3899",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Conroe, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.