Provider Demographics
NPI:1740815018
Name:GONYNOR, BIANCA VENEZIA (APRN)
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:VENEZIA
Last Name:GONYNOR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 WEBB PL
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2467
Mailing Address - Country:US
Mailing Address - Phone:603-742-7900
Mailing Address - Fax:
Practice Address - Street 1:36 MOUNT VERNON ST
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:MA
Practice Address - Zip Code:01949-2215
Practice Address - Country:US
Practice Address - Phone:978-907-3662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-07
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2319076163W00000X, 363LF0000X
NH073780-21163W00000X
NH073780-23363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH073780-23Medicaid