Provider Demographics
NPI:1811408867
Name:BONES, BETHANY DAWN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:DAWN
Last Name:BONES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:DAWN
Other - Last Name:SHIRILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:500 EVERGREEN DR STE 20
Mailing Address - Street 2:
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-1032
Mailing Address - Country:US
Mailing Address - Phone:484-785-3376
Mailing Address - Fax:
Practice Address - Street 1:500 EVERGREEN DR STE 20
Practice Address - Street 2:
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-1032
Practice Address - Country:US
Practice Address - Phone:484-785-3376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-17
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA059457363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant