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Individual

ELLEN BONNEVIE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRNA

Contact information

Practice address
123 SUMMER ST, WORCESTER, MA 01608-1216
(508) 363-6030
Mailing address
7 SHOREHAM ST, WORCESTER, MA 01605-3144

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
110314
MA
367500000X
Certified Registered Nurse Anesthetist
Primary
RN110314
MA

Other

Enumeration date
02/13/2007
Last updated
09/02/2014
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