Provider Demographics
NPI:1386930840
Name:BONAMY, GLORIA A (RN)
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:A
Last Name:BONAMY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20853 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLLS
Mailing Address - State:MI
Mailing Address - Zip Code:48322-5183
Mailing Address - Country:US
Mailing Address - Phone:248-476-9091
Mailing Address - Fax:248-476-1011
Practice Address - Street 1:20853 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-5183
Practice Address - Country:US
Practice Address - Phone:248-476-9091
Practice Address - Fax:248-476-1011
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704180761163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse