Healthcare Provider Details

I. General information

NPI: 1336872100
Provider Name (Legal Business Name): PATRICIA BONANNO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 BOSTON POST RD E STE 365A
MARLBOROUGH MA
01752-4819
US

IV. Provider business mailing address

221 BOSTON POST RD E STE 365A
MARLBOROUGH MA
01752-4819
US

V. Phone/Fax

Practice location:
  • Phone: 508-816-5758
  • Fax:
Mailing address:
  • Phone: 508-816-5758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2345626
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: