Provider Demographics
NPI:1023319126
Name:BONANNO, MEGHAN KATHLEEN (FNP)
Entity type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:KATHLEEN
Last Name:BONANNO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:MEGHAN
Other - Middle Name:KATHLEEN
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:19 FAIRWAYS LN
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-2125
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:67 MAIN ST
Practice Address - Street 2:
Practice Address - City:MEDWAY
Practice Address - State:MA
Practice Address - Zip Code:02053-1817
Practice Address - Country:US
Practice Address - Phone:508-533-6771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-06
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN283784363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily