Provider Demographics
NPI:1831282698
Name:DORMAN, BONNIE (CRNA)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:DORMAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 FISHING CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MILL HALL
Mailing Address - State:PA
Mailing Address - Zip Code:17751-9129
Mailing Address - Country:US
Mailing Address - Phone:814-861-2177
Mailing Address - Fax:
Practice Address - Street 1:101 REGENT CT
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-7965
Practice Address - Country:US
Practice Address - Phone:814-231-2102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN173587L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50034874OtherCAPITAL BLUECROSS
PA31588991BOtherGEISINGER HEALTH PLAN
PAP00146203OtherRAILROAD MEDICARE
PARN173587LOtherRN LICENSE NUMBER
PA157063OtherHEALTH AMERICA
PA50034874OtherCAPITAL BLUECROSS