Provider Demographics
NPI:1639322720
Name:BONNES, EMILY TAYLOR (PA-C)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:TAYLOR
Last Name:BONNES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 SPRUCE ST
Mailing Address - Street 2:APT 2R
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-6167
Mailing Address - Country:US
Mailing Address - Phone:804-240-2728
Mailing Address - Fax:
Practice Address - Street 1:1230 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-3814
Practice Address - Country:US
Practice Address - Phone:609-581-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ00210100363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical