Provider Demographics
NPI:1164254850
Name:BONANNO, ALESSANDRA ISABELLA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ALESSANDRA
Middle Name:ISABELLA
Last Name:BONANNO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7804 CAPITOL HILL LN
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4006
Mailing Address - Country:US
Mailing Address - Phone:309-256-0915
Mailing Address - Fax:
Practice Address - Street 1:9000 N MAIN ST STE 233
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45415-1184
Practice Address - Country:US
Practice Address - Phone:937-832-9310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.008932RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant