Provider Demographics
NPI:1144813817
Name:BONITATIBUS, EMILY (FNP)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:
Last Name:BONITATIBUS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:NULLET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25 WATERVIEW EST
Mailing Address - Street 2:
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-4436
Mailing Address - Country:US
Mailing Address - Phone:914-391-1528
Mailing Address - Fax:
Practice Address - Street 1:10 CRANBERRY DR
Practice Address - Street 2:
Practice Address - City:HOPEWELL JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:12533-5367
Practice Address - Country:US
Practice Address - Phone:845-231-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-14
Last Update Date:2021-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF345530-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily