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General NPI Number Information
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NPI Number | 1740815018
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Entity Type | Individual
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Provider Name | BIANCA VENEZIA GONYNOR APRN
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Gender | Female
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Dates
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Enumeration Date | 03/07/2020
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Last Update Date | 07/29/2021
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Provider Practice Location Address
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Address Line | 36 MOUNT VERNON ST
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City | MIDDLETON
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State | MA
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Zip | 01949-2215
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Country | US
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Telephone | 978-907-3662
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Fax |
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Provider Business Mailing Address
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Address Line | 14 WEBB PL
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City | DOVER
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State | NH
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Zip | 03820-2467
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Country | US
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Telephone | 603-742-7900
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN2319076
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 073780-21
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License Number State | NH
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN2319076
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 073780-23
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License Number State | NH
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