Provider Demographics
NPI:1447260138
Name:BONNER, MARGARET MARY (RNCS,PC)
Entity type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:MARY
Last Name:BONNER
Suffix:
Gender:F
Credentials:RNCS,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 SPEAR STREET
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169
Mailing Address - Country:US
Mailing Address - Phone:617-770-4203
Mailing Address - Fax:617-773-1972
Practice Address - Street 1:22 SPEAR STREET
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169
Practice Address - Country:US
Practice Address - Phone:617-770-4203
Practice Address - Fax:617-773-1972
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA166473363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPN0645OtherBCBS
MANS0222Medicare ID - Type Unspecified