Individual
BONITA MRAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
150 MUNDY ST, WILKES BARRE, PA 18702-6830
(570) 824-0930
(570) 824-7755
Mailing address
150 MUNDY ST, WILKES BARRE, PA 18702-6830
(570) 824-0930
(570) 824-7755
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA-001134-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
019762
BLUE CARE
PA
05
—
103207018-0001
—
PA
01
—
50076566
CAPITAL BLUE CROSS
PA
01
—
P00120630
RAILROAD MEDICARE
PA
Enumeration date
09/15/2005
Last updated
11/09/2016
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