Provider Demographics
NPI:1083595151
Name:BONINU, JEWEL ELIZABETH
Entity type:Individual
Prefix:
First Name:JEWEL
Middle Name:ELIZABETH
Last Name:BONINU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2283 LAUREL RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NARVON
Mailing Address - State:PA
Mailing Address - Zip Code:17555-9736
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2283 LAUREL RIDGE RD
Practice Address - Street 2:
Practice Address - City:NARVON
Practice Address - State:PA
Practice Address - Zip Code:17555-9736
Practice Address - Country:US
Practice Address - Phone:717-874-8850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2255A2300X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer