| Organization Name: | HEALTHCARE STAT |
| NPI Number: | 1609029644 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SHAWN P BONILLA (OWNER) |
| Mailing Address: | 821 E. Veterans Memorial Highway Blanchard |
| State: | OK US |
| Postal Code: | 730109215 |
| Phone Number: | 4054859588 |
| Fax Number: | 4057015421 |
| NPI Enumeration Date: | 11/03/2008 |
| NPI Last Update Date: | 07/15/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP2300X |
| License Number: | R0068442 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OK |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |