Healthcare Provider Details

I. General information

NPI: 1841627353
Provider Name (Legal Business Name): BAOKIM NGUYEN BONELLI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2013
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 WELLS ST STE 203
WESTERLY RI
02891-2923
US

IV. Provider business mailing address

15 LA SALLE SQ
PROVIDENCE RI
02903-1814
US

V. Phone/Fax

Practice location:
  • Phone: 401-348-0660
  • Fax: 401-348-3090
Mailing address:
  • Phone: 401-444-6779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA01411
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: