Provider Demographics
NPI:1285783027
Name:PAINE, BONNIE MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:MARIE
Last Name:PAINE
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 1:24430 STONE SPRINGS BLVD STE 515
Mailing Address - Street 2:
Mailing Address - City:DULLES
Mailing Address - State:VA
Mailing Address - Zip Code:20166-2268
Mailing Address - Country:US
Mailing Address - Phone:571-385-1221
Mailing Address - Fax:800-223-4063
Practice Address - Street 1:24430 STONE SPRINGS BLVD STE 515
Practice Address - Street 2:
Practice Address - City:DULLES
Practice Address - State:VA
Practice Address - Zip Code:20166-2268
Practice Address - Country:US
Practice Address - Phone:571-385-1221
Practice Address - Fax:800-223-4063
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
VA0110002143363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1417027608OtherRMH GROUP NPI
VA1447764857OtherTWELVESTONE GROUP NPI
VA1538316203OtherGROUP NPI