Basic Information
| Provider Information | |||||||||
| NPI: | 1740272889 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMSON | ||||||||
| FirstName: | BONNIE | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 490 E NORTH AVE | ||||||||
| Address2: | SUITE 307 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152124740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4123350582 | ||||||||
| FaxNumber: | 4123596620 | ||||||||
| Practice Location | |||||||||
| Address1: | 490 E NORTH AVE | ||||||||
| Address2: | SUITE 307 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152124740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4123595822 | ||||||||
| FaxNumber: | 4123596620 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2005 | ||||||||
| LastUpdateDate: | 05/05/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | TP000691A | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
ID Information
| ID | Type | State | Issuer | Description | 1021827380001 | 05 | PA | MEDICAID |