Provider Demographics
NPI:1700612009
Name:BONNER, BRIDGET (MSN, CRNP, CPNP-PC)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:BONNER
Suffix:
Gender:F
Credentials:MSN, CRNP, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:WOODBURY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08097-1206
Mailing Address - Country:US
Mailing Address - Phone:856-628-2549
Mailing Address - Fax:
Practice Address - Street 1:269 FISH POND RD
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-3047
Practice Address - Country:US
Practice Address - Phone:856-863-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15136800363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics