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General NPI Number Information
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NPI Number | 1184942138
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Entity Type | Individual
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Provider Name | BRIDGET ANTONIA BONELLO FPN
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Gender | Female
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Dates
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Enumeration Date | 05/13/2010
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Last Update Date | 05/13/2010
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Provider Practice Location Address
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Address Line | 3333 BIDDLE AVE
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City | WYANDOTTE
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State | MI
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Zip | 48192-6284
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Country | US
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Telephone | 734-285-2405
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Fax |
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Provider Business Mailing Address
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Address Line | 30159 APPLE GROVE WAY
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City | FLAT ROCK
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State | MI
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Zip | 48134-2736
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Country | US
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Telephone | 734-782-4095
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 4704195983
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License Number State | MI
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