Healthcare Provider Details

I. General information

NPI: 1982128070
Provider Name (Legal Business Name): REBECCA CONKLIN BONO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2017
Last Update Date: 07/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 ELECTRONICS PKWY
LIVERPOOL NY
13088-6001
US

IV. Provider business mailing address

417 ELECTRONICS PKWY
LIVERPOOL NY
13088-6001
US

V. Phone/Fax

Practice location:
  • Phone: 315-432-0027
  • Fax:
Mailing address:
  • Phone: 315-432-0027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number527235-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: