Provider Demographics
NPI:1265558399
Name:BONANNO, DENISE PATRICIA (RN)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:PATRICIA
Last Name:BONANNO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CLEMENTI LN
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-6480
Mailing Address - Country:US
Mailing Address - Phone:978-975-2683
Mailing Address - Fax:
Practice Address - Street 1:7 CLEMENTI LN
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-6480
Practice Address - Country:US
Practice Address - Phone:978-975-2683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA187044163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0799858OtherPROVIDER NUMBER