Provider Demographics
NPI:1699389858
Name:BONOMO, CAITLIN THOMAS (CPNP-AC)
Entity Type:Individual
Prefix:MRS
First Name:CAITLIN
Middle Name:THOMAS
Last Name:BONOMO
Suffix:
Gender:F
Credentials:CPNP-AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 JORDAN MILL CT
Mailing Address - Street 2:
Mailing Address - City:WHITE HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21161-9032
Mailing Address - Country:US
Mailing Address - Phone:443-690-1491
Mailing Address - Fax:
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-6453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR206319363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics