Provider Demographics
NPI:1609988427
Name:AYOTTE, BONITA JEAN (ANP-C)
Entity Type:Individual
Prefix:MS
First Name:BONITA
Middle Name:JEAN
Last Name:AYOTTE
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 FRYE RD
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04348-3216
Mailing Address - Country:US
Mailing Address - Phone:207-549-7865
Mailing Address - Fax:
Practice Address - Street 1:VETERANS ADMINISTRATION
Practice Address - Street 2:1 VA CENTER
Practice Address - City:TOGUS
Practice Address - State:ME
Practice Address - Zip Code:04330-6796
Practice Address - Country:US
Practice Address - Phone:207-623-8411
Practice Address - Fax:207-621-4892
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER014580363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health