Provider Demographics
NPI:1588643050
Name:BONYUN, MARY DENISE (MS)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:DENISE
Last Name:BONYUN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1183 S HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:STOWE
Mailing Address - State:VT
Mailing Address - Zip Code:05672-5121
Mailing Address - Country:US
Mailing Address - Phone:802-847-4519
Mailing Address - Fax:802-847-4664
Practice Address - Street 1:112 COLCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1417
Practice Address - Country:US
Practice Address - Phone:802-847-4519
Practice Address - Fax:802-847-4664
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT99190170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS