Provider Demographics
NPI:1376809079
Name:BONJUKIAN, HOLLAN BETH (CPT, CNC, BA)
Entity Type:Individual
Prefix:MRS
First Name:HOLLAN
Middle Name:BETH
Last Name:BONJUKIAN
Suffix:
Gender:F
Credentials:CPT, CNC, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 WHITNEY DR
Mailing Address - Street 2:
Mailing Address - City:AVERILL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12018-3754
Mailing Address - Country:US
Mailing Address - Phone:518-496-0337
Mailing Address - Fax:
Practice Address - Street 1:36 WHITNEY DR
Practice Address - Street 2:
Practice Address - City:AVERILL PARK
Practice Address - State:NY
Practice Address - Zip Code:12018-3754
Practice Address - Country:US
Practice Address - Phone:518-496-0337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No174H00000XOther Service ProvidersHealth Educator