Provider Demographics
NPI:1841350907
Name:BONTRAGER, LISA CHRISTINE (CNM)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:CHRISTINE
Last Name:BONTRAGER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:BUCKEYSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21717-0069
Mailing Address - Country:US
Mailing Address - Phone:240-341-4974
Mailing Address - Fax:304-461-6522
Practice Address - Street 1:3620 BUCKEYSTOWN PIKE
Practice Address - Street 2:
Practice Address - City:BUCKEYSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21717
Practice Address - Country:US
Practice Address - Phone:240-341-4974
Practice Address - Fax:304-461-6522
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2018-03-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDR150210367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife