Individual
MS. BONNY C NOTHERN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
45 DIMOCK ST, ROXBURY, MA 02119-1208
(617) 442-8800
(617) 541-8472
Mailing address
705 MOUNT AUBURN ST, BEWELL CENTER, WATERTOWN, MA 02472-1508
(617) 972-1053
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
RN236176
MA
363LA2200X
Adult Health Nurse Practitioner
MA236176
MA
363LA2200X
Adult Health Nurse Practitioner
Primary
RN236176
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP472601
—
MA
Enumeration date
07/12/2006
Last updated
05/28/2021
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