Healthcare Provider Details

I. General information

NPI: 1497701155
Provider Name (Legal Business Name): KRISTEN G BONAVILLA CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 FLICKINGER CT
AMHERST NY
14228-3393
US

IV. Provider business mailing address

24 FLICKINGER CT
AMHERST NY
14228-3395
US

V. Phone/Fax

Practice location:
  • Phone: 610-428-5286
  • Fax:
Mailing address:
  • Phone: 610-428-5286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0002X
TaxonomyHigh-Risk Obstetric Registered Nurse
License Number558493-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number001205-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: