MEDICARE: BARBRA BONSU

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	363LF0000X	Family Nurse Practitioner	R213477	MD

General Provider Information

NPI Number	:	1710384482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBRA BONSU

Provider Business Mailing Address
First Line	:	9701 APOLLO DR STE 100
Second Line	:
City	:	LARGO
State	:	MD
Zip	:	20774-4785
Country	:	US
Telephone Number	:	240-397-6694
Fax Number	:

Provider Business Practice Location Address
First Line	:	2421 RAMBLEWOOD DR
Second Line	:
City	:	DISTRICT HEIGHTS
State	:	MD
Zip	:	20747-2343
Country	:	US
Telephone Number	:	201-397-6694
Fax Number	:

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

Provider Enumeration Date	:	11/24/2014
Last Update Date	:	07/21/2022

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Directions to “ BARBRA BONSU ” Practice Location

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