Provider Demographics
NPI:1760770036
Name:BONGIORNO, BEVERLY LYNN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:LYNN
Last Name:BONGIORNO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 BRIGGS RD
Mailing Address - Street 2:SUITE 148
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-4103
Mailing Address - Country:US
Mailing Address - Phone:856-222-1975
Mailing Address - Fax:856-222-0721
Practice Address - Street 1:1025 BRIGGS RD
Practice Address - Street 2:SUITE 148
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-4103
Practice Address - Country:US
Practice Address - Phone:856-222-1975
Practice Address - Fax:856-222-0721
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00340200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily