Provider Demographics
NPI:1407684376
Name:BONNEAU, CHRISTINE MICHELLE (PMHNP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MICHELLE
Last Name:BONNEAU
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 MAIN STREET
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:HOPKINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01748
Mailing Address - Country:US
Mailing Address - Phone:508-589-5333
Mailing Address - Fax:774-250-2693
Practice Address - Street 1:77 MAIN STREET
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:HOPKINTON
Practice Address - State:MA
Practice Address - Zip Code:01748
Practice Address - Country:US
Practice Address - Phone:508-589-5333
Practice Address - Fax:774-250-2693
Is Sole Proprietor?:No
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2310719363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health