Individual
MIA ISABELLA BONASSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
135 PROFESSIONAL PL, BRIDGEPORT, WV 26330-4509
(681) 342-3660
Mailing address
135 PROFESSIONAL PL, BRIDGEPORT, WV 26330-4509
(681) 342-3660
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
2721
WV
363AM0700X
Medical Physician Assistant
Primary
MA064426
PA
Other
Enumeration date
03/31/2023
Last updated
03/30/2026
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