Provider Demographics
NPI:1194163931
Name:BONIFACIO, MARGARET H (RN, PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:H
Last Name:BONIFACIO
Suffix:
Gender:F
Credentials:RN, PMHNP-BC
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Mailing Address - Street 1:PO BOX 5777
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37802-5777
Mailing Address - Country:US
Mailing Address - Phone:865-246-2104
Mailing Address - Fax:865-246-2106
Practice Address - Street 1:9325 S NORTHSHORE DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-6548
Practice Address - Country:US
Practice Address - Phone:865-387-2904
Practice Address - Fax:865-246-2106
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN0000017637363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health