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General NPI Number Information
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NPI Number | 1740617141
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Entity Type | Individual
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Provider Name | ROSALIE ANNE BONUS PA
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Gender | Female
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Dates
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Enumeration Date | 09/30/2013
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Last Update Date | 10/24/2019
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Provider Practice Location Address
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Address Line | 3580 PEACH ST SUITE 100
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City | ERIE
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State | PA
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Zip | 16508-2776
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Country | US
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Telephone | 814-868-9633
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Fax | 814-866-1436
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Provider Business Mailing Address
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Address Line | 11279 PERRY HWY SUITE 450
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City | WEXFORD
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State | PA
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Zip | 15090-9381
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Country | US
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Telephone | 724-933-1100
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Fax | 724-933-1160
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA056367
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License Number State | PA
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