Provider Demographics
NPI:1316095532
Name:BONK-CHANIN, AMY (PA-C)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:BONK-CHANIN
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 1:5575 POPLAR AVE
Mailing Address - Street 2:#504
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3856
Mailing Address - Country:US
Mailing Address - Phone:901-761-1850
Mailing Address - Fax:901-761-1822
Practice Address - Street 1:5575 POPLAR AVE
Practice Address - Street 2:SUITE #504
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3856
Practice Address - Country:US
Practice Address - Phone:901-761-1850
Practice Address - Fax:901-761-1822
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN277363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical