Individual
MS. HOLLY L BONAVIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1575 N RIVERCENTER DR, #124, MILWAUKEE, WI 53212-3965
(414) 283-8444
(414) 283-8450
Mailing address
3301 W FOREST HOME AVE, MILWAUKEE, WI 53215-2843
(414) 647-6326
(414) 671-8860
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
3124-28
WI
363A00000X
Physician Assistant
Primary
753-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42951300
—
WI
Enumeration date
08/05/2006
Last updated
11/24/2021
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