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General NPI Number Information
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NPI Number | 1285783027
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Entity Type | Individual
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Provider Name | BONNIE MARIE PAINE PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 24430 STONE SPRINGS BLVD STE 515
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City | DULLES
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State | VA
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Zip | 20166-2268
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Country | US
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Telephone | 571-385-1221
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Fax | 800-223-4063
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Provider Business Mailing Address
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Address Line | PO BOX 12369
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City | MURFREESBORO
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State | TN
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Zip | 37129-0048
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Country | US
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Telephone | 844-893-0012
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 0110002143
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License Number State | VA
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