Provider Demographics
NPI:1730189317
Name:BONUS, STACEY M (CRNP)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:M
Last Name:BONUS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 NORTH FRANKLIN DRIVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301
Mailing Address - Country:US
Mailing Address - Phone:724-225-6500
Mailing Address - Fax:724-225-8188
Practice Address - Street 1:125 NORTH FRANKLIN DRIVE
Practice Address - Street 2:SUITE 1
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301
Practice Address - Country:US
Practice Address - Phone:724-225-6500
Practice Address - Fax:724-225-8188
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007882363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP007882OtherCRNP
PASP007882OtherCRNP
PAQ11068Medicare UPIN