Healthcare Provider Details

I. General information

NPI: 1497754436
Provider Name (Legal Business Name): BONNIE WILLIAMS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3413 CHERRY ST
ERIE PA
16508-2678
US

IV. Provider business mailing address

3413 CHERRY ST
ERIE PA
16508-2678
US

V. Phone/Fax

Practice location:
  • Phone: 814-868-9828
  • Fax: 814-868-8561
Mailing address:
  • Phone: 814-868-9828
  • Fax: 814-868-8561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD050886L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036088153
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: