MEDICARE: BIANCA VENEZIA GONYNOR APRN

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	163W00000X	Registered Nurse	RN2319076	MA
2	163W00000X	Registered Nurse	073780-21	NH
3	363LF0000X	Family Nurse Practitioner	RN2319076	MA
4	363L00000X	Nurse Practitioner	073780-23	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740815018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BIANCA VENEZIA GONYNOR APRN

Provider Business Mailing Address
First Line	:	14 WEBB PL
Second Line	:
City	:	DOVER
State	:	NH
Zip	:	03820-2467
Country	:	US
Telephone Number	:	603-742-7900
Fax Number	:

Provider Business Practice Location Address
First Line	:	36 MOUNT VERNON ST
Second Line	:
City	:	MIDDLETON
State	:	MA
Zip	:	01949-2215
Country	:	US
Telephone Number	:	978-907-3662
Fax Number	:

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

Provider Enumeration Date	:	03/07/2020
Last Update Date	:	07/29/2021

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