Provider Demographics
NPI:1447554761
Name:BONOMI, KATHERINE
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:BONOMI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 PENNSYLVANIA AVE
Mailing Address - Street 2:APT 2
Mailing Address - City:MATAMORAS
Mailing Address - State:PA
Mailing Address - Zip Code:18336-1450
Mailing Address - Country:US
Mailing Address - Phone:412-304-3488
Mailing Address - Fax:
Practice Address - Street 1:103 PENNSYLVANIA AVE
Practice Address - Street 2:APT 2
Practice Address - City:MATAMORAS
Practice Address - State:PA
Practice Address - Zip Code:18336-1450
Practice Address - Country:US
Practice Address - Phone:412-304-3488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303439-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse