Provider Demographics
NPI:1306327812
Name:WOODRUFF, BONNIE MARIE (DNP, PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:MARIE
Last Name:WOODRUFF
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC
Other - Prefix:MS
Other - First Name:BONNIE
Other - Middle Name:WOODRUFF
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1048 PENNSYLVANIA AVE W
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-1838
Mailing Address - Country:US
Mailing Address - Phone:814-230-9111
Mailing Address - Fax:814-313-1075
Practice Address - Street 1:1048 PENNSYLVANIA AVE W
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-1838
Practice Address - Country:US
Practice Address - Phone:814-230-9111
Practice Address - Fax:814-313-1075
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018639363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP018639OtherPASBON