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NPI Code Detail

MEDICARE: MS. BONNY C NOTHERN NP

MEDICARE: MS. BONNY C NOTHERN NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse PractitionerRN236176MA
2363LA2200XAdult Health Nurse PractitionerMA236176MA
3363LA2200XAdult Health Nurse PractitionerRN236176MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1538194865
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. BONNY C NOTHERN NP
Provider Business Mailing Address
First Line : 705 MOUNT AUBURN ST
Second Line : BEWELL CENTER
City : WATERTOWN
State : MA
Zip : 02472-1508
Country : US
Telephone Number : 617-972-1053
Fax Number :
Provider Business Practice Location Address
First Line : 45 DIMOCK ST
Second Line :
City : ROXBURY
State : MA
Zip : 02119-1208
Country : US
Telephone Number : 617-442-8800
Fax Number : 617-541-8472
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2006
Last Update Date : 05/28/2021

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