Provider Demographics
NPI:1740617141
Name:BONUS, ROSALIE ANNE (PA)
Entity Type:Individual
Prefix:
First Name:ROSALIE
Middle Name:ANNE
Last Name:BONUS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ROSALIE
Other - Middle Name:ANNE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11279 PERRY HWY
Mailing Address - Street 2:SUITE 450
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9381
Mailing Address - Country:US
Mailing Address - Phone:724-933-1100
Mailing Address - Fax:724-933-1160
Practice Address - Street 1:3580 PEACH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2776
Practice Address - Country:US
Practice Address - Phone:814-868-9633
Practice Address - Fax:814-866-1436
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056367363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant