Healthcare Provider Details

I. General information

NPI: 1841475316
Provider Name (Legal Business Name): JEANNE MARIE BONADONNA PHD, CNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 01/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 ASHLEY AVE
CHARLESTON SC
29425-8905
US

IV. Provider business mailing address

169 ASHLEY AVE PO BOX 250347
CHARLESTON SC
29425-8905
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-6657
  • Fax: 843-792-9166
Mailing address:
  • Phone: 843-792-6657
  • Fax: 843-792-9166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberR45396
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: