Provider Demographics
NPI:1891034856
Name:BONNER, BRITTANI D (PA-C)
Entity Type:Individual
Prefix:
First Name:BRITTANI
Middle Name:D
Last Name:BONNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3235 BRIDGE RD STE 15
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-1780
Mailing Address - Country:US
Mailing Address - Phone:757-606-1656
Mailing Address - Fax:757-606-1657
Practice Address - Street 1:3235 BRIDGE RD STE 15
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-1780
Practice Address - Country:US
Practice Address - Phone:757-606-1656
Practice Address - Fax:757-606-1657
Is Sole Proprietor?:No
Enumeration Date:2013-02-11
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-04003363A00000X
VA0110008551363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-04003OtherNC MEDCIAL BOARD LICENSE
NC0010-04003OtherNC MEDCIAL BOARD LICENSE