Healthcare Provider Details

I. General information

NPI: 1730287798
Provider Name (Legal Business Name): BONNIE ANN WASSON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 05/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 US ROUTE 30
GEORGETOWN PA
15043-1133
US

IV. Provider business mailing address

2905 US ROUTE 30
GEORGETOWN PA
15043-1133
US

V. Phone/Fax

Practice location:
  • Phone: 724-573-5509
  • Fax:
Mailing address:
  • Phone: 724-573-5509
  • Fax: 724-775-3510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN311572L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP007843
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: