Provider Demographics
NPI:1457316945
Name:BONNER, CYNTHIA LOUISE
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:LOUISE
Last Name:BONNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14605-2929
Mailing Address - Country:US
Mailing Address - Phone:585-546-2771
Mailing Address - Fax:585-454-7001
Practice Address - Street 1:114 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14605-2929
Practice Address - Country:US
Practice Address - Phone:585-546-2771
Practice Address - Fax:585-454-7001
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN336421L163W00000X
PATP003006G363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS19421Medicare UPIN
PABO577947OtherHIGHMARK