Provider Demographics
NPI:1740379338
Name:BIONDOLILLO, BONNIE (RN)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:BIONDOLILLO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14702-0457
Mailing Address - Country:US
Mailing Address - Phone:716-488-1971
Mailing Address - Fax:716-483-6878
Practice Address - Street 1:332 E 4TH ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-5502
Practice Address - Country:US
Practice Address - Phone:716-488-1971
Practice Address - Fax:716-483-6878
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000548101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health