Provider Demographics
NPI:1871893594
Name:DZIESINSKI, BONNIE JO (PA)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:JO
Last Name:DZIESINSKI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:JO
Other - Last Name:VOORHIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1275 DICK LONAS RD UNIT 101
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1383
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:865-584-1363
Practice Address - Street 1:2217 E LAMAR ALEXANDER PKWY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5311
Practice Address - Country:US
Practice Address - Phone:865-982-0835
Practice Address - Fax:833-908-2144
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2021-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1895363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant