MEDICARE: DR. BONNIE KREBS PH D

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
1	103T00000X	Psychologist	417	RI

General Provider Information

NPI Number	:	1306854633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BONNIE KREBS PH D

Provider Business Mailing Address
First Line	:	PO BOX 834
Second Line	:
City	:	WAKEFIELD
State	:	RI
Zip	:	02880
Country	:	US
Telephone Number	:	401-782-0046
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 NORTH RD
Second Line	:
City	:	PEACE DALE
State	:	RI
Zip	:	02879
Country	:	US
Telephone Number	:	401-782-0046
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	07/08/2007

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