Provider Demographics
NPI:1972656387
Name:BONAIUTO, KATHLEEN DALY (PNP)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:DALY
Last Name:BONAIUTO
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-6214
Mailing Address - Country:US
Mailing Address - Phone:978-354-2720
Mailing Address - Fax:978-740-4702
Practice Address - Street 1:81 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2714
Practice Address - Country:US
Practice Address - Phone:978-354-2720
Practice Address - Fax:978-740-4702
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA147113363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAQ32695Medicare UPIN
NP9977Medicare ID - Type Unspecified