| Organization Name: | THE BONIN CLINIC LLC |
| NPI Number: | 1003280512 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | OTTO J BONIN (OWNER) |
| Mailing Address: | 1215 Independence Blvd 1a Zachary |
| State: | LA US |
| Postal Code: | 707917390 |
| Phone Number: | 2255702010 |
| Fax Number: | 2255708573 |
| NPI Enumeration Date: | 11/20/2015 |
| NPI Last Update Date: | 02/24/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | AP04429 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |