Provider Demographics
NPI:1639728629
Name:BONHAM, LILLIAN (LDN)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:
Last Name:BONHAM
Suffix:
Gender:F
Credentials:LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 CAMBRIDGE LN STE A
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-3329
Mailing Address - Country:US
Mailing Address - Phone:215-968-5151
Mailing Address - Fax:215-968-5252
Practice Address - Street 1:31 CAMBRIDGE LN STE A
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-3329
Practice Address - Country:US
Practice Address - Phone:215-968-5151
Practice Address - Fax:215-968-5252
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN006841133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered