Provider Demographics
NPI:1366481657
Name:DUGAN, BONNIE S (ANPC)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:S
Last Name:DUGAN
Suffix:
Gender:F
Credentials:ANPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 COLLEGE PARKWAY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221
Mailing Address - Country:US
Mailing Address - Phone:716-626-9900
Mailing Address - Fax:716-626-9100
Practice Address - Street 1:100 COLLEGE PARKWAY
Practice Address - Street 2:SUITE 220
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6800
Practice Address - Country:US
Practice Address - Phone:716-626-9900
Practice Address - Fax:716-626-9100
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF303760-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02522952Medicaid
NYQ20217Medicare UPIN
NY02522952Medicaid