Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 292307 | NY |
NPI | 1215315965 |
---|---|
Provider Name | Mary Elizabeth Bonnet |
First Address | Rochester, NY 14618-3960 |
Second Address | Rochester, NY 14618-3960 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2015 |
Last Update Date | 19/08/2019 |