Provider Demographics
NPI:1407270689
Name:BONNETTE, HOLLY MILCH (NP, RN)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:MILCH
Last Name:BONNETTE
Suffix:
Gender:F
Credentials:NP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PARKMAN ST
Mailing Address - Street 2:SUITE 460
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-3117
Mailing Address - Country:US
Mailing Address - Phone:617-643-5580
Mailing Address - Fax:617-643-4613
Practice Address - Street 1:15 PARKMAN ST
Practice Address - Street 2:SUITE 460
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3117
Practice Address - Country:US
Practice Address - Phone:617-643-5580
Practice Address - Fax:617-643-4613
Is Sole Proprietor?:No
Enumeration Date:2014-02-10
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2284339163W00000X
MA2014009231363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1407270689Medicaid