Provider Demographics
NPI:1497701155
Name:BONAVILLA, KRISTEN G (CNM)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:G
Last Name:BONAVILLA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 FLICKINGER CT
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-3395
Mailing Address - Country:US
Mailing Address - Phone:610-428-5286
Mailing Address - Fax:
Practice Address - Street 1:24 FLICKINGER CT
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-3393
Practice Address - Country:US
Practice Address - Phone:610-428-5286
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY558493-1163WX0002X
NY001205-1176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-Risk
Not Answered176B00000XOther Service ProvidersMidwife