Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0102X | Surgical Critical Care | 25MA09658400 | NJ |
N | 2086S0127X | Trauma Surgeon | 25MA09658400 | NJ |
NPI | 1225294507 |
---|---|
Provider Name | Dr. Stephanie Lynn Bonne |
First Address | Newark, NJ 07103-2757 |
Second Address | Newark, NJ 07103-2757 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2008 |
Last Update Date | 21/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0476277 | (05) | NJ |