Provider Demographics
NPI:1184915548
Name:BONOMO, MARIANNE (NP)
Entity type:Individual
Prefix:MS
First Name:MARIANNE
Middle Name:
Last Name:BONOMO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 3RD ST
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43971-1208
Mailing Address - Country:US
Mailing Address - Phone:740-457-8186
Mailing Address - Fax:734-661-0730
Practice Address - Street 1:2000 GREEN RD
Practice Address - Street 2:SUITE 300
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-1598
Practice Address - Country:US
Practice Address - Phone:734-995-3764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV29901363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily