# MS. BETH A BONIFAS

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1639226939
- **Gender:** F
- **Credential:** NP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | 0017136969 | VA | Yes |
| 363LP0200X | Pediatric Nurse Practitioner | 0017136969 | VA | — |

## Other

- **Enumeration date:** 01/05/2007
- **Last updated:** 07/27/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 010418071 | — | VA |
| 01 | — | 012862C41 | MEDICARE | VA |
| 05 | — | 7003969 | — | NC |