Provider Demographics
NPI:1013245661
Name:YOUNG, BONNIE TONG (ACNP)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:TONG
Last Name:YOUNG
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:
Other - Last Name:TONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1010 SUMMERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:PA
Mailing Address - Zip Code:18414-9622
Mailing Address - Country:US
Mailing Address - Phone:917-892-7569
Mailing Address - Fax:
Practice Address - Street 1:1000 E MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18711-0027
Practice Address - Country:US
Practice Address - Phone:570-808-6020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-19
Last Update Date:2020-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016507363LA2100X
NYF430472-1363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care