Provider Demographics
NPI:1154627610
Name:DAVIS, BONITA ANN (RD)
Entity Type:Individual
Prefix:MRS
First Name:BONITA
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:BONITA
Other - Middle Name:ANN
Other - Last Name:YOUNK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:681 SNYDER HILL RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-8711
Mailing Address - Country:US
Mailing Address - Phone:607-277-2943
Mailing Address - Fax:
Practice Address - Street 1:681 SNYDER HILL RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-8711
Practice Address - Country:US
Practice Address - Phone:607-277-2943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
817922133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered