Provider Demographics
NPI:1770691727
Name:ADAMSON, BONITA J (CRNA)
Entity type:Individual
Prefix:
First Name:BONITA
Middle Name:J
Last Name:ADAMSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2671 ELMS PLANTATION BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9165
Mailing Address - Country:US
Mailing Address - Phone:843-797-6800
Mailing Address - Fax:
Practice Address - Street 1:2671 ELMS PLANTATION BLVD
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9165
Practice Address - Country:US
Practice Address - Phone:843-797-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2012-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC34447367500000X
SC154367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN1281Medicaid
SCGP2825Medicaid
SCQ33000Medicare ID - Type Unspecified
SCGP2825Medicaid
SC7386Medicare PIN