Provider Demographics
NPI:1629683115
Name:BONNER, MEGHAN (CRNP)
Entity Type:Individual
Prefix:MISS
First Name:MEGHAN
Middle Name:
Last Name:BONNER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1367
Mailing Address - Country:US
Mailing Address - Phone:215-370-1874
Mailing Address - Fax:
Practice Address - Street 1:333 N OXFORD VALLEY RD STE 102
Practice Address - Street 2:
Practice Address - City:FAIRLESS HILLS
Practice Address - State:PA
Practice Address - Zip Code:19030-2626
Practice Address - Country:US
Practice Address - Phone:215-547-6611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP021737363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology