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NPI Code Detail

MEDICARE: EMMA GERRETY BONWELL PA

MEDICARE: EMMA GERRETY BONWELL PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA.0008110CO

General Provider Information

NPI Number : 1124739024
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMMA GERRETY BONWELL PA
Provider Business Mailing Address
First Line : 1815 JET WING DR
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80916-2300
Country : US
Telephone Number : 719-632-5700
Fax Number :
Provider Business Practice Location Address
First Line : 1815 JET WING DR
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80916-2300
Country : US
Telephone Number : 719-632-5700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2022
Last Update Date : 02/04/2026

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Directions to “ EMMA GERRETY BONWELL PA” Practice Location

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