| Doctor Name: | SHAWN PATRICK BONILLA |
| NPI Number: | 1134213978 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | N.P. |
| License Number: | ROO68442 |
| Business Practice Address: | 821 E Veterans Memorial Hwy Blanchard, OK - 730109215 |
| Business Phone Number: | 4056595656 |
| Business Fax Number: | 4057015421 |
| Mailing Address: | Po Box 5908, NORMAN |
| State: | OK |
| Postal Code: | 730705908 |
| Phone Number: | 4056595656 |
| Fax Number: | 4057015421 |
| NPI Enumeration Date: | 10/03/2006 |
| NPI Last Update Date: | 03/24/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2100X |
| License Number: | ROO68442 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Acute Care |
| Taxonomy Definition: | |