Provider Demographics
NPI:1568500361
Name:BONELLA, DAWN M (CRNP)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:BONELLA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MISS
Other - First Name:DAWN
Other - Middle Name:M
Other - Last Name:ROWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:255 W LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1763
Mailing Address - Country:US
Mailing Address - Phone:484-565-1600
Mailing Address - Fax:610-647-2006
Practice Address - Street 1:255 W LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1763
Practice Address - Country:US
Practice Address - Phone:484-565-1600
Practice Address - Fax:610-647-2006
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009317363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA232359401OtherMLHC TIN
PA232359401OtherMLHC TIN
PA120758XRUMedicare PIN