Individual
BONNIE J ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
689 HOGAN RD, BANGOR, ME 04401-3605
(207) 873-1131
(207) 872-6014
Mailing address
36 SILVER ST, WATERVILLE, ME 04901-6514
(207) 877-5068
(207) 872-6014
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
—
ME
224P00000X
Prosthetist
—
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1669590147
—
ME
Enumeration date
11/06/2023
Last updated
11/13/2023
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