Individual
ELAINE K BONOAN
Active
Individual
ELAINE K BONOAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
000894
CT
363AM0700X
Medical Physician Assistant
Primary
000894
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000894
PA-C LICENSE
CT
01
—
029227
CONTROLLED SUBSTANCE LIC
CT
Enumeration date
09/28/2006
Last updated
03/07/2023
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