Individual
TARA LYNN BONOVITCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2141 UNION AVE, ERIE, PA 16510-1745
(814) 520-4263
Mailing address
2141 UNION AVE, ERIE, PA 16510-1745
(814) 520-4263
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN287536
PA
Other
Enumeration date
10/21/2011
Last updated
10/21/2011
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