Provider Demographics
NPI:1891891040
Name:BENETATO, BONNIE BERNICE (RN, FNP,PHD)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:BERNICE
Last Name:BENETATO
Suffix:
Gender:F
Credentials:RN, FNP,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 CYPRESS SHORE RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-8555
Mailing Address - Country:US
Mailing Address - Phone:202-549-7885
Mailing Address - Fax:
Practice Address - Street 1:800 MOYE BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3777
Practice Address - Country:US
Practice Address - Phone:252-830-2149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5005558363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCRN54697OtherNURSING LICINSE