Individual
ALICE R BONNER
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
GNP
Contact information
Practice address
630 PLANTATION ST, WORCESTER, MA 01605-2038
(508) 595-2000
(508) 853-7149
Mailing address
630 PLANTATION ST, WOT 12TH FL ATTN: PHYSICIAN SERVICES, WORCESTER, MA 01605-2038
(508) 368-5529
(508) 368-5530
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
179601
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04247226
ONE HEALTH PLAN
—
01
—
042472266008
TRICARE CHAMPUS
—
01
—
0700363
MEDICAID WELFARE
—
05
—
0700363
—
MA
01
—
57691
FALLON COMMUNITY HEALTH
—
01
—
8300310
EVERCARE
—
01
—
AA3457
HARVARD PILGRIM HEALTHCAR
—
01
—
NP0040
BLUE SHIELD HMO BLUE
—
Enumeration date
12/09/2005
Last updated
07/08/2007
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